What is antimicrobial therapy for cholera?

Updated: Feb 03, 2021
  • Author: Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI; Chief Editor: Russell W Steele, MD  more...
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Answer

Table 6. Antimicrobial Therapy Used in the Treatment of Cholera* (Open Table in a new window)

Antibiotic

Single Dose (PO)

Multiple Dose (PO)

Doxycycline

7 mg/kg; not to exceed 300 mg/dose

2 mg/kg bid on day 1; then 2 mg/kg qd on days 2 and 3; not to exceed 100 mg/dose

Tetracycline

25 mg/kg; not to exceed 1 g/dose

40 mg/kg/d divided qid for 3 d; not to exceed 2 g/d

Furazolidone

7 mg/kg; not to exceed 300 mg/dose

5 mg/kg/d divided qid for 3 d; not to exceed 400 mg/d

Trimethoprim and sulfamethoxazole

Not evaluated

< 2 months: Contraindicated

≥2 months: 5-10 mg/kg/d (based on trimethoprim component) divided bid for 3 d; not to exceed 320 mg/d trimethoprim and 1.6 g/d of sulfamethoxazole

Ciprofloxacin§

30 mg/kg; not to exceed 1 g/dose

30 mg/kg/d divided q12h for 3 d; not to exceed 2 g/d

Ampicillin

Not evaluated

50 mg/kg/d divided qid for 3 d; not to exceed 2 g/d

Erythromycin

Not evaluated

40 mg/kg/d erythromycin base divided tid for 3 d; not to exceed 1 g/d

* Antimicrobial therapy is an adjunct to fluid therapy of cholera and is not an essential component. However, it reduces diarrhea volume and duration by approximately 50%. The choice of antibiotics is determined by the susceptibility patterns of the local strains of V cholerae O1 or O139.

Tetracycline and doxycycline can discolor permanent teeth of children younger than 8 years. However, the risk is small when these drugs are used for short courses of therapy, especially if used in a single dose.

Single-dose therapy of these drugs has not been evaluated systematically in children, and recommendations are extrapolated from experience in adults.

§ Fluoroquinolones (eg, ciprofloxacin) are not approved in the United States for use in persons younger than 18 years. When given in high doses to juvenile animals, they cause arthropathy. Clinical experience indicates that this risk is very small in children when used for short courses of therapy.