Background
Although the mainstay of cholera treatment remains rehydration, treatment with antibiotics is recommended in serious forms and on specific sites. However, since the late 1970s, resistance to antibiotics in strains of Vibrio cholerae (Vc) has been observed and now threatens the effective treatment and control of cholera.
Objective and Methods
This cross-sectional, retro-prospective, descriptive and analytical study aims to describe the long-term evolution of the antibiotic resistance profile of Vibrio choleraeO1 strains isolated at the provincial public health laboratory of North Kivu during cholera epidemics in Eastern Democratic Republic of Congo (DRC) from January 1, 2011 to June 30, 2022.
Results
A total of 4832 isolates of Vibrio cholerae O1 were collected, more than half of them (72.46%, n=3175) in the province of North Kivu. Of the 3 serotypes, Vc O1 Inaba was the majority (57.6%, n=2522). Among the 4382 strains of Vc O1, very high levels of resistance were found to ampicillin (74.7%), nalidixic acid (83.8%), erythromycin (73.6%), chloramphenicol (68.8%) and Sulfamethoxazole/Trimethoprim (82%). A resistance of 30% (1316/4382) was found to doxycycline, a molecule recommended by the WHO as first-line in the treatment of cholera. We found 27 different resistance profiles (MDR) with respect to the 5 main molecules recommended in anticholera therapy. In the analytical study, we observed a statistically significant evolution over time (p=0.000) of these MDR profiles, including 5% in 2011 against nearly 40% between 2021 and 2022; with a distribution statistically dependent on age (p=0.0003) including 57.4% of cases in children under 15 (27% in those under 5); with a predominance (69%) in the province of North Kivu.
Conclusion
The resistance of Vibrio cholerae 01 to common antibiotics is high in eastern DRC and tends to increase over time. The abusive and inappropriate use of antibiotics is one of the major causes of this emergence of antimicrobial resistance. Close monitoring and measures for the proper use of antibiotics will be necessary to stem this scourge.
We conducted a study to evaluate the tolerance of the zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving AZT-3TC-NVP combination between 2008 and 2011. Seventy patients were included. Two thirds of the patients presented at least one side effect (44 cases). The digestive disorders (15 cases) and neuropsychiatric (14 cases) were the most frequent. Epigastralgia (20%), headaches (20%) and arthralgias (13%) were main side effects. A maculo-papular exanthema was noted in three cases. During the follow-up, five patients presented with anemia. No patient presented hepatic cytolysis due to NVP. All the patients followed for more than six months presented a side effect against 29.7% when the duration of treatment was equal to or less than 6 months (p=10(-5)). Most of the side effects due to the association AZT/3TC/NVP are minor. The evaluation of the clinical and biological tolerance must be maintained during all the follow-up.
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