New treatment option for children with cholera

Results of a study in this week’s issue of THE LANCET suggest that the antibiotic azithromycin could be an effective treatment option for children with cholera.

Cholera is a major public-health problem which is greatly under-reported; children are most affected by this bacterial disease which causes severe diarrhoea resulting in dehydration. Around 5000 deaths from cholera were reported to the WHO in 2000, probably a severe underestimate as Bangladesh—where over 200,000 people are infected with the cholera bacterium—has not supplied WHO with data relating to cholera illness or death.

Effective single-dose antibiotics have only been identified for adults with cholera; single-dose regimens are especially desirable for children to increase compliance. Wasif Khan from the Centre for Health and Population Research, Dhaka, Bangladesh, and colleagues did a randomised study of 128 severely dehydrated children with cholera, treated at one of two treatment centres in Bangladesh in 1999. Children were assigned either single-dose azithromycin (20 mg/kg bodyweight or 12·5 mg/kg erythromycin every six hours for 3 days.

Although treatment success was similar in both groups, children given azithromycin had reduced duration of diarrhoea compared with those given erythromycin—24 hours compared with 42 hours, respectively. Vomiting was also reduced in children given azithromycin (one case compared with four cases in the erythromycin group).

The investigators comment how cost may be the real issue affecting future drug treatment of childhood cholera—azithromycin is five times more expensive than co-trimoxazole and 50% more expensive than erythromycin.

Wasif A Khan comments: “Whether or not the potential advantages of single-dose azithromycin—increased compliance, simplified logistics, reduction in vomiting—justify the additional cost when compared with other drug regimens is a decision that individual treatment centres involved in the care of children with cholera will have to make.”