Vibrio cholerae infection (cholera)

Cholera is caused by Vibrio cholerae serotypes O1 and O139. Infection is usually acquired overseas (eg in returned travellers) in countries with inadequate access to clean water and sanitation and, rarely, from consumption of imported seafood from endemic areas.

The mainstay of treatment for cholera is rehydration. Antibiotic therapy reduces the volume and duration of diarrhoea; considerCenters for Disease Control and Prevention ((CDC), 2022Kanungo, 2022:

1azithromycin 1 g (child: 20 mg/kg up to 1 g) orally, as a single dose azithromycin azithromycin azithromycin

OR

1ciprofloxacin 1 g (child: 20 mg/kg up to 1 g) orally, as a single dose12. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment ciprofloxacin ciprofloxacin ciprofloxacin

OR

1doxycycline orally, as a single dose34 doxycycline doxycycline doxycycline

adult and child 12 years or older: 300 mg

children younger than 12 years: 4 mg/kg up to 300 mg.

Antibiotic-resistant strains of V. cholerae are now common in some regions. In the event of clinical failure, treatment should be guided by the results of susceptibility testing.

An oral cholera vaccine is available and is recommended for travellers who have a high risk of exposure; for more information see the Australian Immunisation Handbook.

1 Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Ciprofloxacin can be used in children when it is the drug of choice.Return
2 An oral liquid formulation of ciprofloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return
3 Doxycycline use is limited in children because an oral liquid formulation is not marketed in Australia but is available via the Special Access Scheme. For formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return
4 When used short term (eg less than 21 days), doxycycline has not been associated with tooth discolouration, enamel hypoplasia or bone deposition so can be used in children of all ages.Return