0548. Single-dose treatment for paediatric cholera

Cholera is a major global health problem in children in cholera-endemic areas in the developing world, and health economic theory dictates that one should seek treatment regimens that are effective, safe, affordable, promote compliance and minimise resource utilisation, Current WHO recommendations are that paediatric treatment should be based on 3-day, 12-dose regimens involving erythromycin or tetracycline, however erythromycin has significant gastrointestinal effects that are counter-productive in the context of cholera while tetracycline still raises concerns about staining of teeth. Other drugs such as chloramphenicol and co-trimoxazole have been discarded either because of narrow spectrum or resistance. Azithromycin has been shown to be effective in a single dose, but to add to the armamentarium researchers have also studied ciprofloxacin (the latter enjoying acceptance after concerns about arthropathy were allayed). A recent randomized study involving researchers in the US and UK and study populations in Bangladesh and Mtubatuba (KZN) showed that ciprofloxacin suspension at 20mg/kg (to a max of 750mg) was at least as effective as erythromycin in children aged between 2 and 15 years. Watery stools resolved within the required 48 hours, and ciprofloxacin also achieved better secondary outcome measures (less vomiting, fewer stools over 5 study days, lower stool volume). The only downside was a lower rate of bacterial clearance with ciprofloxacin (mainly in younger and/or malnourished patients), and while the authors state that the public health importance of this finding is uncertain they nevertheless conclude that ciprofloxacin is an appropriate alternative to currently-recommended treatment. An accompanying editorial comment should also be noted - it agrees with the rationale for a single-dose regimen but steers towards azithromycin rather than ciprofloxacin, both of which are off patent and would be affordable in the developing world.

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Lancet 2005; 366; 1085-93 and 1054-5
Lancet 2002; 360: 1722-27
Acta Paediatr 2003; 92: 676-78