Academic journal article Journal of Health Population and Nutrition

Tetracycline in the Treatment of Severe Cholera Due to Vibrio Cholerae O139 Bengal

Academic journal article Journal of Health Population and Nutrition

Tetracycline in the Treatment of Severe Cholera Due to Vibrio Cholerae O139 Bengal

Article excerpt

INTRODUCTION

Clinical spectrum of infection due to Vibrio cholerae varies widely-ranging from asymptomatic infection to severe disease which is characterized by frequent passage of voluminous watery stools, vomiting, dehydration, hypovolaemic shock, and sometimes, death (1). Until recently, V. cholerae O1 has been the only recognized serogroup among 138 serogroups causing epidemic cholera (2,3); other serogroups have been associated with sporadic diarrhoea without causing epidemics (4). Recently, a new serogroup of V. cholerae, designated V. cholerae O139 synonym Bengal (5), has been reported to cause large epidemics of severe dehydrating diarrhoea in India and Bangladesh (6-8). However, the pathophysiologic mechanism and clinical course of the disease, caused by V. cholerae O139 Bengal, have not been characterized well but reported to be similar to those of V. cholerae O1 (9-11).

Management of dehydration and antimicrobial treatment remain the mainstay in the treatment of cholera. Studies in the early 1960s have shown that antimicrobial therapy reduces the duration of illness, stool volume and requirement of rehydration fluids, and shortens the duration of faecal excretion of V. cholerae O1 (12-14). However, the therapeutic effects of antibiotics on the natural course of cholera caused by V. cholerae O139 have not been evaluated. We, therefore, conducted a randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy of tetracycline in the treatment of adults with severe cholera due to V. cholerae O139 Bengal.

MATERIALS AND METHODS

Estimation of sample size

With reference to total stool volume in cholera patients not treated with antimicrobial agents (24), a pre-trial sample size of 21 patients in each group was estimated to detect a 50% reduction in total stool volume treated with tetracycline to give a power of 80% at a significance level of 5%.

Selection of patients

The study was conducted at the Clinical Research and Service Centre (CRSC) of ICDDR,B: Centre for Health and Population Research during September-November 1993. The CRSC provides treatment to 100,000- 120,000 diarrhoeal patients each year. Every 4th male patient, aged 18-60 years, seeking treatment at the CRSC with a history of watery diarrhoea of less than 12 hours with some or severe dehydration as per the WHO guidelines (17) and presence of motile vibrios on dark-field microscopic examination of stool (15), not receiving any antimicrobial therapy for the current illness, was considered eligible for this study. Patients with clinical evidence of any concurrent illnesses were excluded. Written informed consents were obtained from patients for participation in the study.

Management of patients

On admission to the study, patients were weighed and placed on a 'Cholera Cot' for collection of stool unmixed with urine (16). Medical history was obtained either from the patients or from attending relatives. Physical examinations, including assessment of dehydration (17), were performed, and the findings were recorded. Patients were then rehydrated with a polyelectrolyte solution (sodium 133 mMol/L, potassium 13 mMol/L, chloride 98 mMol/L, and bicarbonate 48 mMol/L), following the WHO guidelines (18,19). Rice-based oral rehydration solution (ORS) was used as the maintenance fluid (20) during the course of their illness. The same intravenous polyelectrolyte solution was used for patients whose hydration status could not be maintained with oral rehydration fluid due to excessive vomiting and/or very high rates of purging. Fluid intake (intravenous and oral rehydration fluids, plain water, and milk) and output (volume and weight of liquid stools, urine, and vomitus) were recorded for the initial rehydration phase and for the subsequent 8-hourly periods of the study. Radial pulse and respiration rates, oral temperature, and blood pressures were recorded on admission and 8-hourly during the study. …

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