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oral rehydration therapy
Mapping cholera outbreaks and antibiotic resistant Vibrio cholerae in India: An assessment of existing data and a scoping review of the literature
Pranab Chatterjee | Suman Kanungo | Sujit K. Bhattacharya | Shanta Dutta
Date of Publication:
February 29, 2020
Although fluid and electrolyte replenishment remains the mainstay of clinical management of cholera, antibiotics are an important component of the strategy for clinical management of moderate to severe cases of cholera. The emergence of antibiotic resistance (ABR) in Vibrio cholerae has led to difficulties in case management. The past decade has also seen the development of cheap and effective oral cholera vaccines (OCVs). In addition to the two-dose strategy for widespread immunization, OCVs have also been shown to be effective in containing outbreaks using a single-dose schedule. In this scoping review we map the states and union territories (SUTs) of India which are prone to cholera outbreaks followed by a scoping review of peer-reviewed publications about ABR outbreaks of cholera employing the Arksey and O’Malley framework. Using the data reported by the Integrated Disease Surveillance Program (IDSP), we identified 559 outbreaks of cholera between 2009 and 2017, affecting 27 SUTs. We defined SUTs which had reported outbreaks in at least three out of the last five years (2012–2016) or had experienced two or more outbreaks in the same year in at least two of the last five years to be outbreak-prone. The scoping review identified 62 ABR outbreaks, with four SUTs accounting for two-thirds of them: West Bengal (14), Maharashtra (10), Odisha (10) and Delhi (7). Overall, this scoping review suggests that there is an increasing trend of ABR in Vibrio cholerae isolated from outbreaks in India. This opens up avenues for exploring the role of antibiotic stewardship in the clinical management of diarrhea, the institution of vaccination as an infection prevention intervention to reduce selection pressure, and the deployment of high quality surveillance systems which report accurate, real-time data allowing appropriate and timely public health responses. It is crucial to counter the issue of ABR in cholera before it assumes a menacing magnitude.
Brian Y. Hsueh | Christopher M. Waters
Date of Publication:
Cholera infections caused by the gamma-proteobacterium Vibrio cholerae have ravaged human populations for centuries, and cholera pandemics have afflicted every corner of the globe. Fortunately, interventions such as oral rehydration therapy, antibiotics/antimicrobials, and vaccines have saved countless people afflicted with cholera, and new interventions such as probiotics and phage therapy are being developed as promising approaches to treat even more cholera infections. Although current therapies are mostly effective and can reduce disease transmission, cholera outbreaks remain deadly, as was seen during recent outbreaks in Haiti, Ethiopia, and Yemen. This is due to significant underlying political and socioeconomic complications, including shortages of vaccines and clean food and water and a lack of health surveillance. In this review, we highlight the strengths and weaknesses of current cholera therapies, discuss emerging technologies, and argue that a multi-pronged, flexible approach is needed to continue to reduce the worldwide burden of cholera.
Guidelines for the management of paediatric cholera infection: a systematic review of the evidence
Phoebe C. M. Williams | James A. Berkley
Date of Publication:
Paediatrics and International Child Health
Current WHO guidelines for the treatment of paediatric cholera infection (tetracycline 12.5 mg/kg four times daily for 3 days) are based on data which are over a decade old. In an era of increasing antimicrobial resistance, updated review of the appropriate empirical therapy for cholera infection in children (taking account of susceptibility patterns, cost and the risk of adverse events) is necessary. A systematic review of the current published literature on the treatment of cholera infection in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses was undertaken. The initial search produced 256 results, of which eight studies met the inclusion criteria. Quality assessment of the studies was performed as per the Grading of Recommendations Assessment, Development and Evaluation guidelines. In view of the changing non-susceptibility rates worldwide, empirical therapy for cholera infection in paediatric patients should be changed to single-dose azithromycin (20 mg/ kg), a safe and effective medication with ease of administration. Erythromycin (12.5 mg/kg four times daily for 3 days) exhibits similar bacteriological and clinical success and should be listed as a second-line therapy. Fluid resuscitation remains the cornerstone of management of paediatric cholera infection, and prevention of infection by promoting access to clean water and sanitation is paramount.