tetracycline and Dehydration

Topics: Child; Cholera; Dehydration; Humans; Infant; Potassium; Sodium Chloride; Tetracycline; Water-Electrolyte Balance

Topics: Anti-Bacterial Agents; Chloramphenicol; Dehydration; Diarrhea; Gastroenteritis; Humans; Kanamycin; Methicillin; Neomycin; Penicillin G; Polymyxins; Sepsis; Shock, Septic; Streptomycin; Sulfisoxazole; Tetracycline

Vibrio cholerae O139 synonym Bengal, recognized in 1993, is the second member in the list of about 200 serogroups of V. cholerae with epidemic and pandemic potential. Although replacement of fluids and electrolytes remains the cornerstone in the management of cholera, antimicrobial therapy can significantly shorten the duration of diarrhoea, and reduce stool volume and requirements ofrehydration fluids. The role of antimicrobial therapy on the natural course of the disease caused by this relatively new pathogen has not been systematically assessed. A randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the efficacy of tetracycline in the treatment of adults with severe cholera due to V. cholerae O139 Bengal. Forty-three adult males with severe cholera were randomly allocated to receive either 500 mg of tetracycline (n=21) or placebo (n=22) for three consecutive days. Demographic and clinical characteristics of these patients on admission were comparable. Tetracycline therapy was associated with significantly reduced total median (inter-quartile range) stool volume [216.48 (90.18-325.22) mL/kg vs 334.25 (215.12-537.64) mL/kg; p=0.001], higher rates of clinical cure (81% vs 27%; p<0.001), and shorter median (inter-quartile range) duration of diarrhoea [32 (24-48) hours vs 80 (48-104) hours; p<0.001]. The mean +/- (SD) requirement of intravenous fluid was not significantly different between the two groups [146.42 +/- 42.12 mL/kg vs 150.44 +/- 27.21 mL/kg; p=0.70]. The median (inter-quartile range) duration of faecal excretion of V. cholerae O139 was significantly shorter in the tetracycline group than the placebo group [1(1-2) day vs 5 (3-6) days; p<0.001]. The results of the study indicate that tetracycline therapy is clinically useful in the treatment of severe cholera due to V. cholerae O139 Bengal.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cholera; Dehydration; Diarrhea; Double-Blind Method; Fluid Therapy; Humans; Male; Middle Aged; Tetracycline; Time Factors; Vibrio cholerae

Topics: Adolescent; Adult; Ampicillin; Chloramphenicol; Clinical Trials as Topic; Dehydration; Drug Combinations; Dysentery, Bacillary; Female; Fever; Humans; Male; Melena; Microbial Sensitivity Tests; Middle Aged; Pain; Shigella; Shigella boydii; Shigella dysenteriae; Shigella flexneri; Streptomycin; Sulfamethazine; Sulfamethoxazole; Tetracycline; Trimethoprim; Vomiting

Vibrio cholerae O1, Ogawa and Inaba serotypes, both cause severe cholera. We compared clinical and immunological features in patients in Bangladesh infected with these 2 serotypes. Blood was collected from hospitalized Ogawa (N=146) or Inaba (N=191) patients at the acute stage (day 2) and 5 and 19 days later. Ogawa patients were younger than Inaba, presented with shorter duration of diarrhoea, and had more frequent abdominal pain, vomiting and need for intravenous fluids (p<0.05). Inaba patients more frequently had dark-field positive stools (p<0.01). Inaba strains were more susceptible to tetracycline and erythromycin than Ogawa strains (p<0.001). Ogawa infection produced higher plasma vibriocidal as well as IgG responses to cholera toxin B subunit, toxin-coregulated pilus subunit and lipopolysaccharide (LPS); higher IgA responses to LPS in 'antibody in lymphocyte supernatant' (ALS) specimens were also seen. These results suggest that a cholera vaccine based on the Ogawa serotype needs to be further investigated.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibodies, Bacterial; Bangladesh; Child; Child, Preschool; Cholera; Cholera Toxin; Dehydration; Erythromycin; Feces; Female; Humans; Immunoglobulin G; Infant; Lipopolysaccharides; Male; Microbial Sensitivity Tests; Microbial Viability; Middle Aged; Serotyping; Tetracycline; Vibrio cholerae O1; Young Adult

Within 24 hours of returning from a five-week holiday in Pakistan a 15-year-old girl developed vomiting and massive diarrhoea leading to severe dehydration with hypovolaemic shock. The diastolic blood pressure was no longer measurable and prerenal renal failure occurred with a serum creatinine of 4.4 mg/dl and metabolic acidosis (pH 7.21, base excess-16.9 mmol). Initially treatment consisted of rehydration (day 1: 9280 ml, day 2: 4850 ml). The patient's condition rapidly improved and she had voluminous stools. A concurrent urinary infection due to Klebsiella pneumoniae was first treated with cotrimoxazole. As a new strain of Vibrio cholerae, serogroup O 139, was isolated from stool, treatment was changed to tetracycline (50 mg/kg daily). Regaining a good general state she was transferred to an isolation ward on the 6th hospital day. The isolated cholera organism belongs to a nonagglutinating serogroup which is indistinguishable clinically and epidemiologically from the classical Vibrio strains which cause cholera. Since the end of 1992 this new serogroup has been causing an explosive spread of cholera in Bangladesh and India.

Topics: Adolescent; Agglutination Tests; Cholera; Dehydration; Feces; Female; Fluid Therapy; Germany; Humans; Klebsiella Infections; Klebsiella pneumoniae; Pakistan; Serotyping; Shock; Tetracycline; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vibrio cholerae

An epidemic of cholera due to Vibrio cholerae biotype El Tor occurred in 1977 on Tarawa in the Gilbert Islands. No cholera epidemic had occurred there previously and special problems were encountered in both the diagnosis and clinical management. The clinical features of the 585 hospital admissions on Tarawa during the first 64 days of the epidemic were recorded. Eight hospital deaths occurred in this period. A marked increase in cholera among malnourished Gilbertese children was noted. Simplified regimes for management were devised for the circumstances including schemes for oral and intravenous rehydration. Coconut water was used extensively in oral rehydration. Paramedical personnel were used effectively during the epidemic. Prophylactic tetracycline was used in household contacts of patients and was effective in reducing subsequent illness.

Topics: Cholera; Dehydration; Disease Outbreaks; Feces; Humans; Micronesia; Nutrition Disorders; Tetracycline; Vibrio cholerae

Cholera varies greatly in clinical severity; the mortality of untreated severe cholera may be as high as 60% The main clinical feature is dehydration; fluid lost in the stools may amount to 60/. Rehydration is the cornerstone of treatment. The amount of fluid required is approximately 10% of body weight in severe dehydration and 5 to 8% in moderate dehydration. Fluid therapy, which must be individualized, may be successful on its own, but chemo-therapy shortens the duration of illness. Tetracycline (in adults, 40 mg/kg for 2 days; in children, 50 mg/kg for 2 days) reduces the fluid loss and eliminates the causative organisms. Vaccination is of limited value.

Topics: Adult; Bicarbonates; Child; Chloramphenicol; Cholera; Dehydration; Female; Furazolidone; Humans; Lactates; Pregnancy; Tetracycline; Vibrio cholerae

Topics: Acute Kidney Injury; Aged; Bronchopneumonia; Dehydration; Female; Humans; Hypotension; Male; Surgical Procedures, Operative; Tetracycline; Water-Electrolyte Balance

Topics: Acidosis; Administration, Oral; Adolescent; Adult; Aged; Bangladesh; Bicarbonates; Child; Child, Preschool; Cholera; Dehydration; Diarrhea; Female; Glucose; Humans; Infant; Injections, Intravenous; Male; Middle Aged; Refugees; Sodium Chloride; Solutions; Tetracycline; Vomiting; Water-Electrolyte Balance

Topics: Aged; Dehydration; Digoxin; Drug-Related Side Effects and Adverse Reactions; Furosemide; Guanethidine; Humans; Hypertension; Kidney; Kidney Failure, Chronic; Male; Pharmaceutical Preparations; Tetracycline; Uremia

Topics: Administration, Oral; Age Factors; Bicarbonates; Child; Child, Preschool; Chlorides; Cholera; Cholera Vaccines; Dehydration; Feces; Furazolidone; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Intestine, Small; Potassium; Sodium; Tetracycline; Water-Electrolyte Balance

Topics: Acute Kidney Injury; Cholecystitis; Cholera; Dehydration; Diarrhea; Gangrene; Humans; Hyperaldosteronism; Hypokalemia; Parotitis; Respiratory Tract Diseases; Shock; Tetany; Tetracycline; Vibrio cholerae; Water-Electrolyte Balance

Topics: Anti-Bacterial Agents; Cephalothin; Chloramphenicol; Colitis, Ulcerative; Colon; Dehydration; Diagnosis, Differential; Enterocolitis, Pseudomembranous; Female; Furazolidone; Humans; Intubation, Gastrointestinal; Middle Aged; Novobiocin; Otitis; Radiography; Sigmoidoscopy; Tetracycline; Water-Electrolyte Balance

Topics: Acidosis, Respiratory; Acute Disease; Alkalosis; Blood Gas Analysis; Bronchodilator Agents; Catheterization; Chlorides; Dehydration; Heart Failure; Humans; Hypokalemia; Penicillin G; Potassium Chloride; Respiration, Artificial; Respiratory Insufficiency; Respiratory Tract Infections; Tetracycline

Boric acid poisoning in 11 infants, occurring in the newborn nursery as a result of the accidental and inadvertent use of 2.5% boric acid in the preparation of the formulae, is reported. Five of the infants died. All except two exhibited the classical symptomatology of acute boric acid poisoning, namely, diarrhea, vomiting, erythema, exfoliation, desquamation of the skin, and marked central nervous system irritation. Early manifestations of poisoning were nonspecific, and one patient died before skin manifestations were noted. Peritoneal dialysis, instituted in nine cases, was found to be the most effective method of treatment. It is recommended that boric acid, which is of doubtful therapeutic value, should be completely removed from hospitals, dispensaries and pharmacopoeias.

Topics: Acidosis; Anti-Bacterial Agents; Borates; Boric Acids; Color Perception Tests; Dehydration; Diarrhea; Diarrhea, Infantile; Erythema; Exchange Transfusion, Whole Blood; Gastric Lavage; Hypernatremia; Infant; Infant, Newborn; Peritoneal Dialysis; Phenobarbital; Seizures; Tetracycline; Toxicology; Vomiting