Rice-ORS versus glucose-ORS in management of severe cholera due to Vibrio cholerae O139 Bengal: a randomized, controlled clinical trial.

This study examined the comparative efficacies of rice-based oral rehydration solution (R-ORS) and glucose-based oral rehydration solution (G-ORS) in the management of severe cholera due to Vibrio cholerae O139 Bengal that causes epidemic cholera in many developing countries. Stool culture-proved adult male patients with severe cholera due to V. cholerae O139 Bengal were randomly assigned in a 1:1 ratio to receive either R-ORS or G-ORS after their initial rehydration with intravenous (i.v.) fluid and subsequently four hours of observation. They also received the usual hospital diet and tetracycline capsules (500 mg 6 hourly for three days) immediately after their enrollment in the study. The primary outcomes for observation were stool output during the first 24 hours after intervention and treatment failure as measured by the incidence of re-institution of i.v. fluid after initiation of trial therapy and duration of diarrhoea. Of 113 patients finally included in the study, 57 received R-ORS and 56 G-ORS. The admission characteristics of the two treatment groups were comparable. No significant differences in the first 24 hours of median (inter-quartile range) stool output [179 (67-206) g/kg in R-ORS group vs 193 (80-237) g/kg in G-ORS group; p = 0.52], incidences of unscheduled i.v. fluid requirement [21% (12/57) in R-ORS group vs 25% (14/56) in G-ORS group; p = 0.78], and median (inter-quartile range) duration of diarrhoea [32 (24-48) hours in R-ORS group vs 32 (24-56) hours in G-ORS group; p = 0.64] were observed. It is concluded that rice-based ORS is effective but not superior to standard glucose-based ORS in the management of adult males with severe cholera due to V. cholerae O139 Bengal.

Tetracycline in the treatment of severe cholera due to Vibrio cholerae O139 Bengal.

Vibrio cholerae O139 synonym Bengal, recognized in 1993, is the second member in the list of about 200 serogroups of V. cholerae with epidemic and pandemic potential. Although replacement of fluids and electrolytes remains the cornerstone in the management of cholera, antimicrobial therapy can significantly shorten the duration of diarrhoea, and reduce stool volume and requirements ofrehydration fluids. The role of antimicrobial therapy on the natural course of the disease caused by this relatively new pathogen has not been systematically assessed. A randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the efficacy of tetracycline in the treatment of adults with severe cholera due to V. cholerae O139 Bengal. Forty-three adult males with severe cholera were randomly allocated to receive either 500 mg of tetracycline (n=21) or placebo (n=22) for three consecutive days. Demographic and clinical characteristics of these patients on admission were comparable. Tetracycline therapy was associated with significantly reduced total median (inter-quartile range) stool volume [216.48 (90.18-325.22) mL/kg vs 334.25 (215.12-537.64) mL/kg; p=0.001], higher rates of clinical cure (81% vs 27%; p<0.001), and shorter median (inter-quartile range) duration of diarrhoea [32 (24-48) hours vs 80 (48-104) hours; p<0.001]. The mean +/- (SD) requirement of intravenous fluid was not significantly different between the two groups [146.42 +/- 42.12 mL/kg vs 150.44 +/- 27.21 mL/kg; p=0.70]. The median (inter-quartile range) duration of faecal excretion of V. cholerae O139 was significantly shorter in the tetracycline group than the placebo group [1(1-2) day vs 5 (3-6) days; p<0.001]. The results of the study indicate that tetracycline therapy is clinically useful in the treatment of severe cholera due to V. cholerae O139 Bengal.