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Oral antibiotics for suspected cholera

Oral antibiotics for suspected cholera
Class Antibiotic Typical pediatric dose* Adult dose Comment(s)
Tetracyclines Doxycycline 4 to 6 mg/kg (single dose) 300 mg (single dose)
  • Antibiotic resistance to all tetracyclines is common[1].
  • Empiric use is appropriate in epidemics caused by documented susceptible isolates.
  • Not recommended for pregnant women and children less than 8 years of age.
Tetracycline 50 mg/kg/day in 4 equally divided doses, for 3 days 500 mg 4 times per day for 3 days
Macrolides Azithromycin 20 mg/kg (single dose) 1 g (single dose)
  • Single dose azithromycin is preferred therapy[2].
  • Rare reports of macrolide resistance.
Erythromycin 40 mg/kg/day in 4 equally divided doses, for 3 days 500 mg 4 times per day for 3 days
Fluoroquinolones Ciprofloxacin 20 mg/kg (single dose)

1 g (single dose)

In areas with isolates that have reduced susceptibility to fluoroquinolones:

500 mg twice daily for 3 days[3]
  • Reduced susceptibility to fluoroquinolones has been reported in Asia and Africa[2,4].
  • Not recommended for pregnant women and children less than 8 years of age.
* Not to exceed maximum dose.
References:
  1. Yamamoto T, Nair GB, Albert MJ, et al. Survey of in vitro susceptibilities of Vibrio cholerae O1 and O139 to antimicrobial agents. Antimicrob Agents Chemother 1995; 39:241.
  2. Saha D, Karim MM, Khan WA, et al. Single-dose azithromycin for the treatment of cholera in adults. N Engl J Med 2006; 354:2452.
  3. Khan WA, Saha D, Ahmed S, et al. Efficacy of Ciprofloxacin for Treatment of Cholera Associated with Diminished Susceptibility to Ciprofloxacin to Vibrio cholerae O1. PLoS One 2015; 10:e0134921.
  4. Islam MS, Midzi SM, Charimari L, et al. Susceptibility to fluoroquinolones of Vibrio cholerae O1 isolated from diarrheal patients in Zimbabwe. JAMA 2009; 302:2321.
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