title: Single-dose azithromycin for the treatment of cholera in adults.
abstract: BACKGROUND
  Single-dose azithromycin is effective in the treatment of severe cholera in children, but its effectiveness in adults has not been evaluated.
  
  
  METHODS
  We conducted a double-blind, randomized trial comparing the equivalence of azithromycin and ciprofloxacin (each given in a single 1-g dose of two 500-mg tablets) among 195 men with severe cholera caused by Vibrio cholerae O1 or O139. Patients were hospitalized for five days. A stool culture was performed daily. Primary outcome measures were clinical success (the cessation of watery stools within 48 hours after drug administration) and bacteriologic success (the inability to isolate V. cholerae after 48 hours).
  
  
  RESULTS
  Therapy was clinically successful in 71 of 97 patients receiving azithromycin (73 percent) and in 26 of 98 patients receiving ciprofloxacin (27 percent) (P<0.001) and bacteriologically successful in 76 of 97 patients receiving azithromycin (78 percent) and in 10 of 98 patients receiving ciprofloxacin (10 percent) (P<0.001). Patients who were treated with azithromycin had a shorter duration of diarrhea than did patients treated with ciprofloxacin (median, 30 vs. 78 hours); a lower frequency of vomiting (43 percent vs. 67 percent); fewer stools (median, 36 vs. 52); and a lower stool volume (median, 114 vs. 322 ml per kilogram of body weight). The median minimal inhibitory concentration of ciprofloxacin for the 177 isolates of V. cholerae O1 was 0.25 mug per milliliter, which was 11 to 83 times as high as that in previous studies at this site.
  
  
  CONCLUSIONS
  Single-dose azithromycin was effective in the treatment of severe cholera in adults. The lack of efficacy of ciprofloxacin may result from its diminished activity against V. cholerae O1 strains currently circulating in Bangladesh. (ClinicalTrials.gov number, NCT00229944.).
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. dsaha@icddrb.org
authors.forename: Debasish
authors.initials: D
authors.lastname: Saha
authors.forename: Mohammad M
authors.initials: MM
authors.lastname: Karim
authors.forename: Wasif A
authors.initials: WA
authors.lastname: Khan
authors.forename: Sabeena
authors.initials: S
authors.lastname: Ahmed
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Salam
authors.forename: Michael L
authors.initials: ML
authors.lastname: Bennish
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D001459:Bangladesh; D002771:Cholera / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D002939:Ciprofloxacin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003967:Diarrhea / Q000209:etiology / Q000628:therapy; D004311:Double-Blind Method; D024881:Drug Resistance, Bacterial; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014734:Vibrio cholerae / Q000145:classification / Q000302:isolation & purification; D014839:Vomiting / Q000209:etiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D017963:Azithromycin