Active Ingredients: Norfloxacin
Nausea and vomiting have been reported as common side effects during the therapy with single-dose doxycycline regimens. A more recent evaluation of this regimen against both V.
Single-dose doxycycline was clinically equivalent to ciprofloxacin in patients infected by V.
The discrepancy in results in patients infected by different serotypes was attributed to different susceptibility patterns to tetracycline among these serotypes rather than to clinical differences. More recently, significant clinical experience has been accumulated with azithromycin, an azalide antimicrobial agent, in patients with cholera in Bangladesh and India.
Two large clinical trials have been conducted in Bangladesh using single-dose regimens. The first study was conducted in 128 children 1-15 year old with severe dehydration 64.
The study followed a randomized-double-blind design and compared oral azithromycin with ciprofloxacin, both given at single-dosing regimens of 1 gr in patients with severe cholera.
However. Therefore, azithromycin was compared to essentially an inactive drug in that trial. Independent predictors of clinical failure in that study identified through multivariate analysis were to have received ciprofloxacin for treatment and severity of illness, as measured by the number of stools before randomization and the volume of stools during the four-hour observation period before staring antimicrobials.
A shorter trial that included 56 children 2-10 year old with confirmed V. Azithromycin was superior to erythromycin in shortening the duration of diarrhea 25.
Quinolones The appearance of strains resistant to common antimicrobials used for the treatment of cholera such as tetracyclines and cotrimoxazole in endemic areas has prompted the search for new alternatives 17, 42, 79.
The fluoroquinolones have emerged as the most promising group of antimicrobials for treating enteric infections. Excellent clinical experience with quinolones in typhoid fever, shigellosis and traveler's diarrhea has been reported around the world.
The advantages of quinolones include a broad spectrum of activity against most pathogens associated with diarrheal diseases including Escherichia coli, Shigella spp. A summary of relevant data from studies conducted with quinolones in patients with cholera is presented in Table 3.
The first fluoroquinolone evaluated against cholera was norfloxacin. The pioneer study was conducted in Calcutta, India, and included adult patients with severe dehydration and confirmed infection by V.
Norfloxacin reduced the volume of stools, duration of diarrhea, and fluid requirements for rehydration, compared with the other two groups. Additionally, excretion of V.
The study was limited by the small number of patients included and the appearance of resistance to trimethoprim-sulfamethoxazole during the study period, which precluded adequate comparison with the standard antimicrobial regimen.
Another study with norfloxacin, conducted during the cholera epidemic in Lima, Peru, in 1991 confirmed the utility of this quinolone in the treatment of severe cholera when given in a multiple dosing regimen 45.
This study included adult patients in a University Hospital in Lima who had proven infection by V. Three study groups were tested in an open, controlled and randomized trial: norfloxacin 800 mg single-dose, norfloxacin 400 mg twice daily for three days, and tetracycline 500 mg four times a day for 3 days.The key to successful treatment of SBP is a knowledge of appropriate fluid infection occurring in patients with the setting in which infection develops.