Abstract:
Background Vibrio cholerae is a highly motile Gram-negative bacterium which is
responsible for 3 million cases of diarrhoeal illness and up to 100,000 deaths per year,
with an increasing burden documented over the past decade. 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. Methods 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 (PRISMA) was undertaken.
International clinical guidelines and studies pertaining to adverse effects associated with
treatments available for cholera infection were also reviewed. Results 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. Conclusions 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.