Medical Service, South Oaks Hospital, Amityville, NY.
Transilvania University, Brasov, Romania; and.
Am J Ther. 2023;30(6):e519-e525. doi: 10.1097/MJT.0000000000001679.
Cholera is a potentially lethal diarrheal disease produced by Vibrio cholerae serotypes O1 El Tor and O139. Known since antiquity, the condition causes epidemics in many areas, particularly in Asia, Africa, and South America. Left untreated, the mortality may reach 50%. The crucial therapeutic intervention is intravenous or oral rehydration and correction of acidosis, dyselectrolytemia, and renal impairment. Antibiotic use represents the main pharmacological intervention.
What are the milestones of the antibiotics use recommended by experts for the pharmacological management of cholera in the past century?
To determine the changes in the experts' approach to the management of cholera and particularly the use of antibiotics as presented in a widely used textbook in the United States.
The chapters describing the management of cholera in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020.
Sulfonamides were recommended in 1947, followed by the introduction of tetracyclines, chloramphenicol, and furazolidone in 1955. The options were restricted in 2000 to doxycycline. In the past decade, patients infected with strains known to have a degree a resistance to tetracyclines were treated with azithromycin or ciprofloxacin. Antibiotic use decreases the volume of stool and the duration of diarrhea but has not been considered lifesaving. Drugs with antimotility, antiemetic, or antisecretory properties are not useful.
The utility of antibiotic use in cholera has been endorsed by experts, but only as an adjunct to rapid and complete fluid and electrolyte replacement.
霍乱是由霍乱弧菌 O1 型埃尔托和 O139 型引起的潜在致命性腹泻病。这种疾病自古以来就为人所知，在许多地区，特别是在亚洲、非洲和南美洲，都会引发流行。如果不加以治疗，死亡率可能达到 50%。关键的治疗干预措施是静脉或口服补液以及纠正酸中毒、电解质紊乱和肾功能损害。抗生素的使用是主要的药物干预措施。
在过去的一个世纪里，专家推荐的用于霍乱药物治疗的抗生素使用的里程碑是什么？
为了确定专家在管理霍乱方面的方法变化，特别是在一本广泛使用的美国教科书上呈现的抗生素使用变化。
从 1927 年到 2020 年出版的 Cecil 医学教科书的 26 个版本中，描述霍乱管理的章节。
1947 年推荐使用磺胺类药物，随后在 1955 年引入了四环素、氯霉素和呋喃唑酮。2000 年，选择减少到多西环素。在过去的十年中，感染已知对四环素具有一定耐药性的菌株的患者接受了阿奇霉素或环丙沙星治疗。抗生素的使用减少了粪便量和腹泻持续时间，但尚未被认为是救生的。具有抗动力、止吐或抗分泌特性的药物没有用。
专家一直认可抗生素在霍乱中的应用，但只是作为快速和完全补充液体和电解质的辅助手段。
