A RANDOMIZED CLINICAL-TRIAL TO COMPARE THE EFFICACY OF ERYTHROMYCIN, AMPICILLIN AND TETRACYCLINE FOR THE TREATMENT OF CHOLERA IN CHILDREN

To compare the clinical outcome of treatment of cholera in children wi th ampicillin, erythromycin or tetracycline, a double-'blind' randomiz ed four-cell trial was carried out in Bangladesh. Ampicillin was chose n as additional therapy for acute respiratory tract infection, present in many subjects with diarrhoea. One hundred and eighty-four children aged 1-5 years who were not wasted, with diarrhoea of duration <48 h, signs of some or severe dehydration, dark-held stool microscopy demon strating Vibrio cholerae, and a baseline purging rate >4 mL/kg/h over 6 h were enrolled in the study. Ampicillin, tetracycline, erythromycin or placebo were given orally every 6 h for 3 d. After 3 d of antibiot ic treatment, diarrhoeal stool volume was significantly reduced in all antibiotic groups, with mean volumes per kg body weight as follows: t etracycline, 318 mL (SEM = 50), ampicillin, 335 mt (SE M = 30); erythr omycin, 323 mt (SEM = 25); placebo, 498 mL (SEM = 37). Compared to tet racycline, the clinical recovery rates by 96 h were 75% with placebo, 91.3% with ampicillin, and 95.7% with eythromycin. Compared to tetracy cline, the total mean times to recovery were increased by 66% with pla cebo (P < 0.001), 25% with ampicillin (P < 0.017), and 9% with erythro mycin (P = 0.37). These results indicated comparable clinical efficacy of tetracycline, ampicillin and erythromycin. We therefore recommend that, unless It cholerae is resistant, ampicillin should be used as a cost-effective alternative to erythromycin for paediatric cholera, esp ecially in children with concomitant acute respiratory infection.