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Observations on 285 Cases on Cholera El Tor Treated with Various Antibiotics by C

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Observations on 285 Cases on Cholera El Tor Treated with Various Antibiotics by C 812 NOTES Observations on 285 Cases on Cholera El Tor Treated with Various Antibiotics by C. UYLANGCO, J. VASCO and V. CALILONG, Department of Health, Republic of the Philippines In view of the increasing application of antibiotics group; 150.7 ml/kg for the kanamycin group; for the treatment of cholera,a, b this study was 138.9 ml/kg for the chlortetracycline group; designed to determine the comparative effectiveness 138.6 ml/kg for the chloramphenicol group; and of different antibiotics which were used orally for 115.1 ml/kg for the tetracycline hydrochloride group. the treatment of certain cases of cholera El Tor. The mean output after 24 hours for the treated groups was 96.6 ml/kg, compared with 302.8 ml/kg Method in the control group. The mean outputs for The study group consisted of 285 adult patients the individual treated groups were: kanamycin admitted to the San Lazaro Hospital, Manila, 136.6 ml/kg, erythromycin 116.5 ml/kg, tetra- between July and December 1965, with the clinical cycline hydrochloride 87.8 ml/kg, chlortetracycine diagnosis, bacteriologically confirmed, of cholera 85.1 ml/kg, chloramphenicol 78.5 ml/kg and El Tor. tetracycline metaphosphate 75 ml/kg. The patients were placed on cholera cots on admis- As far as the mean duration of diarrhoea from sion to the cholera wards, and replacement of fluid the start of treatment is concerned, there was and electrolytes was initiated. Antibiotic treatment a significant difference between the treated group started after a rectal swab had been taken. Of the and the control group; the mean duration in the 285 patients, 39 were given chlortetracycine, 39 tetra- treated group was 43.9 hours, and in the control cycline metaphosphate, 19 tetracycline hydrochlo- group 74.5 hours. Among the treated groups, ride, 46 chloramphenicol, 47 erythromycin, 51 kana- the longest duration was 49.8 hours for the kana- mycin and 44 placebo. The drug or placebo was mycin group and the shortest was 40.3 hours for administered orally in all cases. the tetracycline metaphosphate group. In the various treated groups and the control Table 1 gives the distribution of the duration of group, the mean age varied from 35.3 years diarrhoea in each drug group and in the control to 39.6 years; the mean body-weight varied group. from 42.3 kg to 50.0 kg; the mean duration of Duration of positive culture. It is recognized diarrhoea before admission varied from 8.58 hours that antibiotics shorten the period of excretion of to 12.74 hours; and the mean value of the plasma vibrios in the stool. It was found that the mean specific gravity on admission varied from 1.036 duration of positive stool culture in the tetracycline to 1.038. hydrochloride group was only 1.57 days, followed The dosage for each drug was 250 mg every by 1.59 days in the erythromycin group, 1.66 days 6 hours for 3 days, or a total dose of 3 g. in the tetracycline metaphosphate group, 1.69 days Results in the chlortetracycline group, 3.00 days in the chloramphenicol group, and 3.78 days in the kana- Diarrhoea. The amount of diarrhoea within the it 6.33 the 24 hours admission showed an average mycin group; while took days for stool first after cultures to become negative in the control group. for the treated groups of 146.7 ml/kg compared Table 2 shows the distribution of the duration of with the mean of 157.7 ml/kg in the control group. the and diarrhoea the various treated positive stool cultures for control group The mean outputs for for each drug group. The patients were discharged groups were 178.9 ml/kg for the erythromycin after three consecutive negative rectal swab group; 1 58.Om 1/kg for the tetracycline metaphosphate examinations. a Carpenter, C. C. J., Sack, R. B., Mitra, P. P. & Amount offluid required. There was little differ- Mondal, A. (1964) Bull. Calcutta. Sch. trop. Med., 12, 30-31. ence between treated the b Greenough, W. B., Gordon, R. S., Rosenberg, J. S., the group and control group Davies, B. J. & Benenson, A. S. (1964) Lancet, 1, 355. as to the amount of fluid required for hydration 2111I ANTIBIOTIC TREATMENT OF 285 CHOLERA EL TOR CASES 813 TABLE 1 DURATION OF DIARRHOEA FROM START OF TREATMENT Percentage of patients with diarrhoea Antibiotic Time after start of treatment (days) 1 2 3 4 5 6 7 1 2 Tetracycline hydrochloride l100 84.2 31.7 10.5 Tetracycline metaphosphate 100 68.2 10.3 2.5 Chlortetracycli ne 100 69.2 23.1 2.5 2.5 Chloramphenicol 100 73.9 15.2 6.5 Erythromycin 100 66.0 23.4 2.1 Kanamycin 100 74.5 21.6 7.8 5.9 Control 100 86.4 52.3 36.6 27.7 6.8 4.5 TABLE 2 DURATION OF POSITIVE CULTURE FROM START OF TREATMENT Percentage of patients with positive culture Antibiotic Time after start of treatment (days) 1 2 3 4 5 6 7 181 9 10 1 11 12 13 14 15 Tetracycline hydrochloride 100 36.8 16.3 5.2 Tetracycline metaphosphate 100 51.3 28.2 7.5 2.5 2.5 Chlortetracycli ne 100 35.9 15.1 10.2 5.1 Chloramphenicol 100 82.5 58.7 34.7 8.7 6.5 4.3 2.0 Erythromycin 100 42.5 10.0 4.3 Kanamycin 100 81.3 57.0 35.3 27.3 21.5 17.6 15.7 9.8 3.9 Control 100 95.4 90.9 90.0 81.8 65.9 54.5 25.0 6.8 2.3 2.3 2.3 2.3 2.3 2.3 within the first 8 hours after admission; the range other authors, that antibiotics can shorten the dura- of the mean was from 108.0 ml/kg to 127.0 ml/kg. tion of diarrhoea and the excretion of vibrios in However, between 8 and 24 hours, a marked dif- the stool, and consequently conserve fluid needed ference was observed between the treated groups for hydration. According to our preliminary report, and the control group-the mean amount of fluid as far as the comparison of the effectiveness of required in the control group was 241.4 ml/kg, different kinds of antibiotics is concerned, it seemed while the kanamycin group required 86.4 ml/kg on likely that tetracycline was a little superior to other the average; the tetracycline hydrochloride group, antibiotics in shortening the duration of diarrhoea 83.2 ml/kg; the erythromycin group, 77.5 ml/kg; and the excretion of vibrios in the stool. In this the chlortetracycline group, 67.7 ml/kg; the tetra- study, the effectiveness of chloramphenicol, erythro- cycline metaphosphate group, 55.8 ml/kg and the mycin, kanamycin and three kinds of tetracycline chloramphenicol group, 51.6 ml/kg. was comparable. Discussion The dosage of each drug was 250 mg every It is clear from the results of our trial using 6 hours for 3 days; each drug was thus given five antimicrobial drugs, and from the reports by 12 times and its total dosage was 3 g. 814 NOTES In a previous trial (unpublished data), 500 mg of ers have done,c nor to purge them as had been each drug were given every 6 hours for 2 days. done in Iran." It may be significant to mention The daily dosage in the present trial was thus half here that no secondary cases were brought to that in the previous trial, and the total dosage hospital from the families or contacts of these cases. 1 g less. same The present study gave practically the results c Wallace, C. K., Carpenter, C. C. J., Mitra, P. P., as the previous one as far as the duration of diarrhoea Sack, R. B., Khanra, S. R., Warner, A. S., Duffy, T. P., and excretion of vibrios in the stools were concerned. Abinick, A. & Lewis, G. W. (1965) Trans. roy. Soc. trop. was not to follow cases for a Med. Hyg., 59, 621. It possible these longer dGangarosa, E. J., Saghari, H., Emile, J. & Siadat, H. period to note bacteriological relapse as other work- (1966) Bull. Wid Hlth Org., 34, 363-369. The Drug-sensitivity of Isolates from Cholera El Tor Patients in San Lazaro Hospital, Manila by T. P. PESIGAN and C. Z. GOMEZ, Department ofHealth, Republic of the Philippines, and D. BARUA, WHO Cholera Team a Antibiotics have now come to be generally In addition, the first and last isolates of El Tor accepted as a useful adjunct in the treatment of vibrios from 16 patients treated in San Lazaro cholera.b, c Both classical and El Tor vibrios are Hospital, Manila, in 1964 were examined for their sensitive to most of the commonly used antibiotics, sensitivity to the above antibiotics, while the isolates though the latter are less so. However, streptomycin- from 12 more patients were tested for sensitivity to resistant vibrios have been encountered in Hong chloramphenol, tetracycline and streptomycin only. Kong, and transfer of multiple drug-resistance from In 1965, the sensitivity of 228 recent isolates to Shigella flexneri to Vibrio cholerae has been re- chloramphenicol, tetracycline and streptomycin was ported.d It was therefore considered necessary to determined by the classical agar gutter-plate diffusion determine the drug-sensitivity pattern of strains of method e using 2.5% nutrient agar mixed with dif- El Tor vibrios isolated in the Philippines to recognize ferent concentrations of the drugs.
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