zithromax and Cholera

The burden of diarrheal diseases is very high, accounting for 1.7 to 5 billion cases per year worldwide. Typhoid fever (TF) and cholera are potentially life-threatening infectious diseases, and are mainly transmitted through the consumption of food, drink or water that have been contaminated by the feces or urine of subjects excreting the pathogen. TF is mainly caused by Salmonella typhi, whereas cholera is caused by intestinal infection by the toxin-producing bacterium Vibrio cholerae. These diseases typically affect low- and middle-income countries where housing is overcrowded and water and sanitation are poor, or where conflicts or natural disasters have led to the collapse of the water, sanitation and healthcare systems. Mortality is higher in children under 5 years of age. Regarding their geographical distribution, TF has a high incidence in sub-Saharan Africa, India and south-east Asia, while cholera has a high incidence in a few African countries, particularly in the Horn of Africa and the Arabian Peninsula. In the fight against these diseases, preventive measures are fundamental. With modern air travel, transmissible diseases can spread across continents and oceans in a few days, constituting a threat to global public health. Nowadays, people travel for many reasons, such as tourism and business. Several surveys have shown that a high proportion of travelers lack adequate information on safety issues, such as timely vaccination and prophylactic medications. The main objective of this overview is to provide information to help European travelers to stay healthy while abroad, and thus also to reduce the potential importation of these diseases and their consequent implications for public health and society. The preventive measures to be implemented in the case of travel to countries where these diseases are still endemic are well known: the adoption of safe practices and vaccinations. It is important to stress that an effective preventive strategy should be based both on vaccinations and on hygiene travel guidelines. Furthermore, the emergence of multidrug-resistant strains is becoming a serious problem in the clinical treatment of these diseases. For this reason, vaccination is the main solution.

Topics: Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Azithromycin; Bicarbonates; Cephalosporins; Cholera; Cholera Vaccines; Ciprofloxacin; Drinking Water; Drug Resistance, Bacterial; Endemic Diseases; Epidemics; Europe; Global Burden of Disease; Glucose; Humans; Idarubicin; Potassium Chloride; Prednisone; Ringer's Lactate; Sanitation; Sodium Chloride; Travel; Travel Medicine; Travel-Related Illness; Typhoid Fever; Typhoid-Paratyphoid Vaccines; Vidarabine

Background Vibrio cholerae is a highly motile Gram-negative bacterium which is responsible for 3 million cases of diarrhoeal illness and up to 100,000 deaths per year, with an increasing burden documented over the past decade. Current WHO guidelines for the treatment of paediatric cholera infection (tetracycline 12.5 mg/kg four times daily for 3 days) are based on data which are over a decade old. In an era of increasing antimicrobial resistance, updated review of the appropriate empirical therapy for cholera infection in children (taking account of susceptibility patterns, cost and the risk of adverse events) is necessary. Methods A systematic review of the current published literature on the treatment of cholera infection in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was undertaken. International clinical guidelines and studies pertaining to adverse effects associated with treatments available for cholera infection were also reviewed. Results The initial search produced 256 results, of which eight studies met the inclusion criteria. Quality assessment of the studies was performed as per the Grading of Recommendations Assessment, Development and Evaluation guidelines. Conclusions In view of the changing non-susceptibility rates worldwide, empirical therapy for cholera infection in paediatric patients should be changed to single-dose azithromycin (20 mg/kg), a safe and effective medication with ease of administration. Erythromycin (12.5 mg/kg four times daily for 3 days) exhibits similar bacteriological and clinical success and should be listed as a second-line therapy. Fluid resuscitation remains the cornerstone of management of paediatric cholera infection, and prevention of infection by promoting access to clean water and sanitation is paramount.

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Cholera; Drug Resistance, Bacterial; Drug-Related Side Effects and Adverse Reactions; Erythromycin; Guidelines as Topic; Humans; Infant; Infant, Newborn; Treatment Outcome; Vibrio cholerae; World Health Organization

Diarrhoea is one of the most commonly occurring diseases. This article presents a review of the current state of the treatment of acute infectious diarrhoea, as well as of the most important pathogens. The general principles of the therapy of diarrhoea are exemplified, followed by a description of the targeted antimicrobial therapy of the most important bacterial gastrointestinal infections, including salmonellosis, shigellosis and Campylobacter infections, as well as infections with pathogenic Escherichia coli strains, yersiniosis and cholera. Diarrhoea caused by toxigenic Clostridium difficile strains has increased in incidence and in severity. These infections will therefore be described in detail, including important new aspects of treatment. Symptomatic therapy is still the most important component of the treatment of infectious diarrhoea. However, empirical antibiotic therapy should be considered for severely ill patients with a high frequency of stools, fever, bloody diarrhoea, underlying immune deficiency, advanced age or significant comorbidities. Increasing resistance, in particular against fluoroquinolones, must be taken into consideration. Therapy with motility inhibitors is not recommended for Shiga toxin-producing Escherichia coli (STEC) infections, Clostridium difficile infections (CDI), and severe colitis. The macrocyclic antibiotic fidaxomicin can reduce the rate of recurrent disease in CDI. Furthermore, evidence for the benefits of faecal microbiota transplantation as a treatment option for multiple recurrences of CDI is increasing. In conclusion, the treatment of acute diarrhoea is still primarily supportive. General empirical antibiotic therapy for acute diarrhoea is not evidence-based.

Topics: Acute Disease; Aminoglycosides; Anti-Bacterial Agents; Azithromycin; Bacterial Infections; Campylobacter Infections; Cholera; Ciprofloxacin; Diarrhea; Dysbiosis; Dysentery, Bacillary; Enterocolitis, Pseudomembranous; Escherichia coli Infections; Fidaxomicin; Gastroenteritis; Humans; Rifamycins; Rifaximin; Salmonella Infections; Shiga-Toxigenic Escherichia coli; Yersinia Infections

To compare the clinical and bacteriological success of single dose treatment with azithromycin and ciprofloxacin in children with cholera.. Randomized, open labelled, clinical controlled trial.. Tertiary care hospital.. 180 children between 2-12 years, having watery diarrhea for < or = 24 hr and severe dehydration, who tested positive for Vibrio cholerae by hanging drop examination or culture of stool.. Azithromycin 20 mg/kg single dose (n=91) or Ciprofloxacin 20 mg/kg single dose (n=89). Dehydration was managed according to WHO guidelines.. Clinical success (resolution of diarrhea within 24 hr) and bacteriological success (cessation of excretion of Vibrio cholerae by day 3). Secondary outcome variables included duration of diarrhea, duration of excretion of Vibrio cholerae in stool, fluid requirement, and proportion of children with clinical or bacteriological relapse.. The rate of clinical success was 94.5% (86/91) in children treated with Azithromycin and 70.7% (63/89) in those treated with Ciprofloxacin [RR (95% CI)=1.34 (1.16-1.54); P< 0.001]. Bacteriological success was documented in 100% (91/91) children in Azithromycin group compared to 95.5% (85/89) in Ciprofloxacin group [RR (95% CI)=1.05 (1.00 -1.10); P=0.06]. Patients treated with Azithromycin had a shorter duration of diarrhea [mean(SD) 54.6 (18.6) vs 71.5 (29.6) h; mean difference (95% CI) 16.9 (9.6 -24.2); P<0.001] and lesser duration of excretion of Vibrio cholerae [mean(SD) 34.6 (16.3) vs 52.1 (29.2) h; mean difference (95% CI) 17.5 (0.2 -24.7), P<0.001] in children treated with Azithromycin vs Ciprofloxacin. The amount of intravenous fluid requirement was significantly less among subjects who received Azithromycin as compared to those who received Ciprofloxacin [mean(SD) 4704.7(2188.4) vs 3491.1(1520.5) mL; Mean difference (95% CI) 1213(645.3 - 1781.9); P<0.001]. Proportion of children with bacteriological relapse was comparable in two groups [6.7% (6/89) vs 2.2% (2/91); RR (95% CI) 0.95 (0.89 -1.01); P=0.16]. None of the children in either group had a clinical relapse.. Single dose azithromycin is superior to ciprofloxacin for treating cholera in children.

Topics: Azithromycin; Child; Child, Preschool; Cholera; Ciprofloxacin; Humans; Treatment Failure; Vibrio cholerae

Single-dose azithromycin is effective in the treatment of severe cholera in children, but its effectiveness in adults has not been evaluated.. We conducted a double-blind, randomized trial comparing the equivalence of azithromycin and ciprofloxacin (each given in a single 1-g dose of two 500-mg tablets) among 195 men with severe cholera caused by Vibrio cholerae O1 or O139. Patients were hospitalized for five days. A stool culture was performed daily. Primary outcome measures were clinical success (the cessation of watery stools within 48 hours after drug administration) and bacteriologic success (the inability to isolate V. cholerae after 48 hours).. Therapy was clinically successful in 71 of 97 patients receiving azithromycin (73 percent) and in 26 of 98 patients receiving ciprofloxacin (27 percent) (P<0.001) and bacteriologically successful in 76 of 97 patients receiving azithromycin (78 percent) and in 10 of 98 patients receiving ciprofloxacin (10 percent) (P<0.001). Patients who were treated with azithromycin had a shorter duration of diarrhea than did patients treated with ciprofloxacin (median, 30 vs. 78 hours); a lower frequency of vomiting (43 percent vs. 67 percent); fewer stools (median, 36 vs. 52); and a lower stool volume (median, 114 vs. 322 ml per kilogram of body weight). The median minimal inhibitory concentration of ciprofloxacin for the 177 isolates of V. cholerae O1 was 0.25 mug per milliliter, which was 11 to 83 times as high as that in previous studies at this site.. Single-dose azithromycin was effective in the treatment of severe cholera in adults. The lack of efficacy of ciprofloxacin may result from its diminished activity against V. cholerae O1 strains currently circulating in Bangladesh. (ClinicalTrials.gov number, NCT00229944.).

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bangladesh; Cholera; Ciprofloxacin; Combined Modality Therapy; Diarrhea; Double-Blind Method; Drug Resistance, Bacterial; Fluid Therapy; Humans; Male; Treatment Outcome; Vibrio cholerae; Vomiting

To evaluate the efficacy of azithromycin in the treatment of cholera in children.. A double-blind, randomized, controlled clinical trial on 80 children with acute watery diarrhoea and moderate to severe dehydration compared the efficacy of azithromycin and erythromycin in treating cholera. Data were analysed for 56 patients who were stool culture positive for Vibrio cholerae. In conjunction with rehydration therapy, 29 patients received azithromycin and 27 patients received erythromycin. Patients in the two treatment groups had comparable clinical and blood biochemical characteristics on admission.. Patients who received azithromycin had significantly less stool output, shorter duration of diarrhoea and lower fluid intake compared with patients who received erythromycin.. Azithromycin appears to be superior to erythromycin for treating cholera in children.

Topics: Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Cholera; Double-Blind Method; Erythromycin; Feces; Humans; India; Male; Severity of Illness Index; Treatment Outcome; Vibrio cholerae

Cholera is a major public-health problem, with children most affected. However, effective single-dose antimicrobial regimens have been identified only for adults. Our aim was to compare the efficacy of azithromycin and erythromycin regimens in the treatment of children.. We did a double-blind, randomised study of 128 severely dehydrated children (age 1-15 years) with cholera, treated at one of two treatment centres in Bangladesh in 1999. Children were assigned single-dose azithromycin (20 mg/kg bodyweight, maximum individual dose 1 g; n=65) or 12.5 mg/kg erythromycin (maximum dose 500 mg; n=63) every 6 h for 3 days. Patients stayed in hospital for 5 days. We measured fluid balance every 6 h, and obtained a rectal swab or stool sample for culture daily. Our primary outcome measures were clinical success of treatment-ie, cessation of watery diarrhoea within 48 h-and bacteriological success-ie, absence of Vibrio cholerae O1 or O139 from cultures of stool or rectal swab samples after study day 2. Analysis was per protocol.. Two children in both groups withdrew from the study, and we excluded one child in the erythromycin group. Treatment was clinically successful in 48 (76%) patients who received azithromycin and 39 (65%) who received erythromycin (difference 11%, 95% CI -5 to 27, p=0.244); and bacteriologically successful in 45 (71%) and 49 (82%) patients, respectively (10%, -5 to 25, p=0.261). Patients treated with azithromycin had a shorter duration of diarrhoea (median 24 h vs 42 h; difference 12 h, 0-18 h, p=0.019) and fewer episodes of vomiting (1 vs 4; difference 1 episode, 0-3 episodes, p=0.023).. Single-dose azithromycin is as effective for treatment of cholera in children as standard erythromycin therapy, but is associated with less vomiting.

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Bangladesh; Child; Child, Preschool; Cholera; Double-Blind Method; Drug Administration Schedule; Erythromycin; Feces; Humans; Infant; Male; Treatment Outcome; Vibrio cholerae O1; Vibrio cholerae O139

Topics: Anaerobiosis; Anti-Bacterial Agents; Azithromycin; Cholera; Ciprofloxacin; Doxycycline; Drug Resistance, Bacterial; Genome-Wide Association Study; Humans; Oxygen; Vibrio cholerae

Topics: Alleles; Anti-Bacterial Agents; Azithromycin; Cholera; Ciprofloxacin; Drug Resistance, Bacterial; Feces; Gene Transfer, Horizontal; Genotype; Haiti; Humans; India; Microbial Sensitivity Tests; Mutation; Phenotype; Polymerase Chain Reaction; Sequence Analysis, DNA; Tetracycline; Vibrio cholerae O1

The efficacy of commonly used antibiotics for treating severe cholera has been compromised over time because of the reduced antibiotic susceptibility. This study aimed to describe the rate of detection of

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bangladesh; Child; Cholera; Ciprofloxacin; Drug Resistance, Bacterial; Erythromycin; Female; Furazolidone; Hospitals, Special; Humans; Male; Microbial Sensitivity Tests; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae O1

In 2009 and 2010, more than 6,000 cholera cases were recorded during these outbreaks with more than 80% of cases recorded in Lusaka province. After a five-year break, in 2016 an outbreak occurred in Lusaka, causing more than 1,000 cases of cholera. This study will strengthen the epidemiological information on the changing characteristics of the cholera outbreaks, for treatment, prevention and control of the disease.. This was a laboratory-based descriptive cross-sectional study conducted at the University Teaching Hospital in Lusaka, Zambia. A total of 83. Macrorestriction analysis of the isolates demonstrated high genetic diversity among the isolates with 16 different patterns. The largest pattern comprised 9 isolates while the smallest one had 1 isolate. 2009 and 2010 isolates were highly resistant to nalidixic acid and cotrimoxazole, but highly sensitive to azithromycin and ampicillin. Of the fifty-two isolates from the 2016 cholera outbreak, 90% (47) were sensitive to cotrimoxazole, 94% (49) to tetracycline, and 98% (51) to azithromycin, while 98% (51) were resistant to nalidixic acid and 31(60%) to ampicillin.. macrorestriction analysis demonstrated high genetic diversity among the

Topics: Ampicillin; Anti-Bacterial Agents; Azithromycin; Cholera; Cross-Sectional Studies; Disease Outbreaks; Drug Resistance, Multiple; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genotype; History, 21st Century; Hospitals, Teaching; Humans; Microbial Sensitivity Tests; Serotyping; Vibrio cholerae O1; Zambia

Azithromycin (AZM) is a clinically important antibiotic against Vibrio cholerae, especially for inhibiting V. cholerae colonisation of the intestine and for the treatment of severe cholera in children and pregnant women. An IncA/C plasmid was isolated from two high minimum inhibitory concentration (MIC) AZM-resistant V. cholerae strains of the two mainly pathogenic serogroups (O1 and O139) isolated in China. In the 172 predicted open reading frames (ORFs), 16 genes were related to antibiotic resistance, of which 5 were well-defined genes associated with macrolide resistance. The five macrolide resistance genes distributed in two clusters, mphR-mrx-mph(K) and mel-mph2, flanked by insertion sequence elements and involving two kinds of resistance mechanism. Deletion of the complete region of the two clusters deceased the AZM MIC from ≥64 µg/mL to ≤0.5 µg/mL. This IncA/C plasmid shows great ability to accumulate antibiotic resistance genes. In addition to 11 resistance genes to other antibiotics, 5 macrolide resistance genes with different function were gathered repeatedly through transposition on one plasmid. This genotype could not be simply explained by antibiotic stress applied on the host from the environment or treatment. These phosphorylases and transmembrane transporters might be involved in the transport and metabolism of other non-antibiotic substances, enabling this kind of plasmid to propagate better in the host.

Topics: Anti-Bacterial Agents; Azithromycin; Cholera; DNA Transposable Elements; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Humans; Intestines; Macrolides; Microbial Sensitivity Tests; Plasmids; Vibrio cholerae

This study describes phenotypic, genotypic and antibiotic susceptibility patterns of the strains isolated from the 2012 Sierra Leone cholera outbreak. Rectal swabs were collected from patients and cultured for Vibrio cholerae O1.. The isolates were subjected to multiplex PCR, mismatch amplification mutation assay (MAMA) PCR, pulsed field gel electrophoresis (PFGE), and antibiotic sensitivity tests using disk diffusion and minimum inhibitory concentration (MIC) E-test following standard procedures.. Out of 17 rectal swabs tested, 15 yielded V. cholerae O1 biotype El Tor, serotype Ogawa. All the strains belonged to 'altered' variants as MAMA PCR result showed the presence of classical cholera toxin B. PFGE result revealed four pulse types. Using antibiotic disk diffusion, all the isolates were resistant to erythromycin, chloramphenicol, furazolidone, and trimethoprim/sulfamethoxazole (SXT) except SL1 which was sensitive to chloramphenicol and SXT. All the isolates were sensitive to nalidixic acid, tetracycline, doxycycline, azithromycin, and ciprofloxacin except SL2 which was resistant to nalidixic acid. However, variable sensitivity patterns were observed for kanamycin. The ranges of MIC were 0.125-0.50 mg/l, 0.003-0.023 mg/l and 0.38-0.75 mg/l for azithromycin, ciprofloxacin and tetracycline, respectively.. This study demonstrates that altered variants of V. cholerae O1 of four clonal types were responsible for the 2012 outbreak of cholera in Sierra Leone.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Typing Techniques; Cholera; Ciprofloxacin; Disease Outbreaks; DNA, Bacterial; Dose-Response Relationship, Drug; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genotype; Humans; Microbial Sensitivity Tests; Sierra Leone; Tetracycline; Vibrio cholerae O1

Topics: Anti-Bacterial Agents; Azithromycin; Child, Preschool; Cholera; Dehydration; Diagnosis, Differential; Diarrhea; Epidemics; Fluid Therapy; Haiti; Humans; Infusions, Intravenous; Male; Vibrio cholerae; Vomiting

Topics: Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Cholera; Drug Administration Schedule; Female; Humans; Male

Topics: Anti-Bacterial Agents; Azithromycin; Cholera; Diarrhea; Drug Resistance, Bacterial; Fluid Therapy; Global Health; History, 19th Century; History, 20th Century; Humans; Sanitation; Vibrio cholerae; Water Microbiology