Cochrane Collaboration researchers conducted a review of the effects of
antibiotics for treating people with cholera. After searching for
relevant trials, they included 39 randomized controlled trials (RCTs) enrolling
4623 people with cholera.
What is cholera and how might antibiotics work
Cholera is a form of severe watery diarrhoea, which spreads from person
to person through food and water contaminated with the bacterium Vibrio
cholerae. Cholera is common in places with poor water and sanitation,
and sometimes causes large epidemics with thousands of people falling
Cholera can cause severe dehydration and death, so the main treatment is
to give fluids and salt either orally as oral rehydration salts, or by
injection. By clearing the bacteria earlier than the patients own immune
system, antibiotics could reduce the duration and severity of the
illness, and reduce onward transmission to other people.
What the research says
Antibiotic treatment shortened the duration of diarrhoea by about one
and a half days (the normal duration is between three and four days),
and reduced the total amount of diarrhoea fluid by half. Consequently,
the need for rehydration fluids was also reduced by almost half.
Antibiotic treatment also shortened the period of time where the patient
remains contagious by reducing the duration of excretion of Vibrio
cholerae in the diarrhoea.
The benefits of antibiotics were seen in trials recruiting only people
with severe dehydration, and in those recruiting people with mixed
levels of dehydration.
Tetracycline or azithromycin appear more effective than some of the
other antibiotics tested, but the choice of which antibiotic to use will
depend on local drug resistance.
This research is supported by the Department for International Development’s Evidence Building and Synthesis Research Programme which is led by Liverpool School of Tropical Medicine
Leibovici-Weissman, Y.; Neuberger, A.; Bitterman, R.; Sinclair, D.; Salam, M.A.; Paul, M. Antimicrobial drugs for treating cholera. Cochrane Database of Systematic Reviews (2014) (Issue 6) Art. No.: CD008625. [DOI: 10.1002/14651858.CD008625.pub2]
Antimicrobial drugs for treating cholera