Recent advances in the treatment and prophylaxis of cholera

The utility of antimicrobials in the treatment of cholera is clearly recognized and widely accepted. In recent years the selection of an effective antimicrobial therapy for cholera has been complicated by the appearance of strains resistant to first choice antimicrobials in endemic areas. To deal with these resistant strains researchers have identified the fluoroquinolones as the most promising group of antimicrobials. Clinical trials, discussed in this review, have shown that these antimicrobials, and especially ciprofloxacin, are effective in the treatment of cholera caused by Vibrio cholerae O1 and O139 serotypes. Their utility as a prophylactic measure is less clearly defined but they are potentially useful in high-transmission settings. In general, the use of these potent antimicrobials should be restricted to the management of cholera in adults in areas where multi-resistant strains are prevalent.