Comparative effectiveness of co-trimoxazole and tetracycline in the treatment of Cholera.

The purpose of the study reported here was to compare the bactericidal effectiveness of tetracycline and co-trimoxazole (a combination of sulfamethoxazole and trimethoprim) in treating cholera. The study, an open-ended random trial using adult patients with cholera cases confirmed by stool culture, was carried out in March 1993 at the Cholera Treatment Unit (CTU) of the Hospital de Apoyo Departmental María Auxiliadora in Lima, Peru. A total of 107 subjects were divided into two groups (A and B). The 50 in Group A received 500 mg of tetracycline orally every 6 hours for 3 days; the 57 in Group B received co-trimoxazole (160 mg of trimethoprim and 800 mg of sulfamethoxazole) orally every 12 hours for 3 days. The two groups were comparable in terms of age, sex, duration of symptoms prior to hospital admission, time at which antibiotic treatment was initiated, and clinical evolution. Control stool cultures of specimens obtained after treatment showed Vibrio cholerae O-1 present in 2% of the Group A and 12.3% of the Group B patients, and also showed V. cholerae non-O-1 present in 2% of the Group A patients and 3.5% of the Group B patients. Overall, it was concluded that both therapeutic treatment regimens were effective and that the strains of V. cholerae observed in the southern sector of the city of Lima were still susceptible to both antibiotics.

[Detection of convalescent Vibrio cholerae carriers using the enterotest]. / Detección de portadores de Vibrio cholerae convalecientes mediante el enterotest.

Although the existence of chronic carriers of Vibrio cholerae has been posited, the information in this regard is limited and contradictory. In order to determine the usefulness of the encapsulated string test (enterotest) for detecting V. cholerae in duodenal secretions of biliary origin (biliduodenal secretions), 59 patients (30 males and 29 females) over the age of 15 with clinically and bacteriologically diagnosed cholera were evaluated. All the patients, who were treated at the María Auxiliadora Departmental Hospital in Lima, Peru, were put on the same rehydration regimen and were given 2 g of tetracycline daily for 3 days. Between 24 h and 7 days after completion of the antibiotic treatment the first control tests were performed: culture of biliduodenal secretions obtained using enterotest and culture of feces obtained by rectal swab. No patient had diarrhea at the time of the first test. The biliduodenal secretion cultures revealed the presence of V. cholerae in five patients (8.5%) (four females and one male), while the fecal culture yielded negative results in all cases. One week later the control test was repeated on four of the five patients. All the biliduodenal secretion cultures were negative and only one fecal culture was positive at this stage. The patient in question was subjected to the same control tests one week later and both were negative. It is concluded that enterotest can be a simple, well-tolerated, low-cost method for detecting V. cholerae carriers.

[Treatment of choleriform diarrhea during pregnancy]. / El trataminento de la diarrea coleriforme en la gestación.

A retrospective review was conducted of the clinical histories of 43 pregnant women treated for acute diarrheal disease in the emergency ward of the María Auxiliadora Departmental Hospital (HADMA) in Lima, Peru, and 32 of the histories were selected for this study. These 32 patients had been admitted to the cholera treatment unit (CTU) of the HADMA for acute choleraic diarrhea with moderate or severe dehydration. The objective was to analyze the clinical evolution of the patients, their response to isotonic rehydration therapy (0.9% saline solution), and the consequences for their pregnancies. The following variables were examined: age; trimester of pregnancy; heart rate and mean blood pressure (MBP) at admission; number of hours since last normal urination; duration of diarrhea; degree of dehydration; volume of diarrhea and vomiting; volume of saline solution administered in the first 2 hours and in total; volume of multi-electrolyte solution (MES) or oral rehydration salts (ORS) administered from the second to the sixth hour and in total; and hours between admission to the emergency ward and transfer to the cholera treatment unit (EME/CTU). Logistic regression analysis revealed a direct and statistically significant correlation between the time of recovery of diuresis and the EME/CTU (P = 0.001; r = 0.65), as well as between time of recovery of diuresis and the volume of diarrhea in the first 4 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomized comparison of aztreonam and chloramphenicol in treatment of typhoid fever.

Patients with clinical typhoid fever plus a blood, bone marrow, or bile positive for Salmonella typhi or Salmonella paratyphi were included in an open clinical trial to compare the efficacy of aztreonam (6 g/day [2 g intravenously every 8 h]) given for 10 days with that of chloramphenicol (50 mg/kg of body weight per day [intravenously or orally]) administered for 14 days. A total of 44 patients, 22 in each group, were included in the study, and both groups were comparable in terms of baseline parameters. All patients randomized to receive chloramphenicol completed the 14 days of treatment, while two patients randomized to receive aztreonam developed an intestinal hemorrhage, and a third patient elected to withdraw from the trial. Defervescence occurred more quickly in the subjects receiving chloramphenicol than in those receiving aztreonam (P < 0.05). All patients in the chloramphenicol group were clinically cured during therapy, while four patients (21%) in the group receiving aztreonam were declared clinical treatment failures. None of the 19 patients receiving aztreonam, compared with 7 of 22 (32%) patients receiving chloramphenicol, had a positive blood culture after 24 h of therapy (P < 0.05). Adverse experiences were unusual and mild. In the study, aztreonam was less effective than chloramphenicol with regard to clinical effectiveness and time of defervescence but was more effective in the elimination of the infecting Salmonella organisms from the bloodstream.

Effect of treatment on serum antibody to Hymenolepis nana detected by enzyme-linked immunosorbent assay.

An enzyme-linked immunosorbent assay (ELISA) was developed to measure serum immunoglobulin G antibodies in 65 patients infected with Hymenolepis nana and 30 noninfected patients. Antibody was detected in 51 of 65 (sensitivity, 79%) and 5 of 30 H. nana-negative patients (specificity, 83%). Nine patients infected with H. nana were treated with praziquantel (20 to 25 mg/kg of body weight). Antibody disappeared from the sera at 90 days in six patients, five of whom had eliminated H. nana. Antibody persisted in three patients in whom H. nana infection did not clear after treatment. The H. nana ELISA had a high rate of cross-reactions with sera from patients with cysticercosis (8 of 29 [28%]) and hydatidosis (8 of 23 [35%]). The ELISA for H. nana may be useful for defining the epidemiology of H. nana infections, especially in areas free from cysticercosis and hydatidosis.