Antimicrobial drugs for treating cholera

Abstract

Background Cholera is an acute watery diarrhoea caused by infection with the bacterium Vibrio cholerae, which if severe can cause rapid dehydration and death. Effective management requires early diagnosis and rehydration using oral rehydration salts or intravenous fluids. In this review, we evaluate the additional benefits of treating cholera with antimicrobial drugs. Objectives To quantify the benefit of antimicrobial treatment for patients with cholera, and determine whether there are differences between classes of antimicrobials or dosing schedules. Search methods We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; African Index Medicus; LILACS; Science Citation Index; metaRegister of Controlled Trials; WHO International Clinical Trials Registry Platform; conference proceedings; and reference lists to March 2014. Selection criteria Randomized and quasi‐randomized controlled clinical trials in adults and children with cholera that compared: 1) any antimicrobial treatment with placebo or no treatment; 2) different antimicrobials head‐to‐head; or 3) different dosing schedules or different durations of treatment with the same antimicrobial. Data collection and analysis Two reviewers independently applied inclusion and exclusion criteria, and extracted data from included trials. Diarrhoea duration and stool volume were defined as primary outcomes. We calculated mean difference (MD) or ratio of means (ROM) for continuous outcomes, with 95% confidence intervals (CI), and pooled data using a random‐effects meta‐analysis. The quality of evidence was assessed using the GRADE approach. Main results Thirty‐nine trials were included in this review with 4623 participants. Antimicrobials versus placebo or no treatment Overall, antimicrobial therapy shortened the mean duration of diarrhoea by about a day and a half compared to placebo or no treatment (MD ‐36.77 hours, 95% CI ‐43.51 to ‐30.03, 19 trials, 1013 participants, moderate quality evidence ). Antimicrobial therapy also reduced the total stool volume by 50% (ROM 0.5, 95% CI 0.45 to 0.56, 18 trials, 1042 participants, moderate quality evidence ) and reduced the amount of rehydration fluids required by 40% (ROM 0.60, 95% CI 0.53 to 0.68, 11 trials, 1201 participants, moderate quality evidence ). The mean duration of fecal excretion of vibrios was reduced by almost three days (MD 2.74 days, 95% CI ‐3.07 to ‐2.40, 12 trials, 740 participants, moderate quality evidence). There was substantial heterogeneity in the size of these benefits, probably due to differences in the antibiotic used, the trial methods (particularly effective randomization), and the tim...

Modulation of the multidrug efflux pump EmrD-3 from Vibrio cholerae by Allium sativum extract and the bioactive agent allyl sulfide plus synergistic enhancement of antimicrobial susceptibility by A. sativum extract

“…The causative agent of cholera disease, Vibrio cholerae, a Gram-negative bacterium has evolved several mechanisms to resist antimicrobial agents prescribed to treat severe cases, thereby marginalizing their chemotherapeutic efficacies (Ghosh and Ramamurthy 2011;Kitaoka et al 2011;Leibovici-Weissman et al 2014). Critical antimicrobial resistance mechanisms in V. cholerae include drug target alteration, drug-degrading enzymes, decreased drug permeability, and active drug efflux (Andersen et al 2015;Ghosh and Ramamurthy 2011;Kitaoka et al 2011).…”

A Case Study: Cholera

“…In stool specimens V. cholerae can be easily identified by its characteristic yellow colonies. Physicians think that vibrio only grow in association with salt water [5][6][7].…”

British HIV Association Guidelines on the Use of Vaccines in HIV‐Positive Adults 2015

“…Humans are the only known host. The disease is characterised by sudden onset of profuse watery diarrhoea and responds to fluid‐ and electrolyte‐replacement therapy . In extreme cases, hypotension and death can occur within 6–8 h of the onset of symptoms.…”