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BMJ 2006; 332 doi: (Published 15 June 2006) Cite this as: BMJ 2006;332:1442
  1. Kristina Fister, associate editor (

    Azithromycin works for severe cholera in adults

    The choice of antibiotics for treating cholera is primarily determined by the patterns of bacterial resistance and antibiotic toxicity. Tetracycline and its derivatives have for decades been the antibiotics of choice for treating cholera in adults, but they should be avoided in children and pregnant women. Erythromycin has often been used as an alternative, but, unlike tetracycline, it is not effective in a single dose. Azithromycin, a derivative of erythromycin, has less gastrointestinal toxicity than erythromycin and has been shown effective for treating cholera in children with a single dose.

    Credit: N ENGL J MED

    A recent equivalence trial of a single dose of azithromycin versus a single dose of ciprofloxacin, which had previously been shown to be effective for treating severe cholera in adults, showed that azithromycin was effective, but ciprofloxacin was not. The trial included almost 200 adult men with severe cholera who were treated in one hospital in Bangladesh in a period of a year and a half. Watery stools stopped within two days of giving azithromycin in more than 70% of patients. Ciprofloxacin was clinically effective in less than a third of people randomised to receive this drug. Similarly, azithromycin eliminated Vibrio cholerae from stool within two days from the start of treatment in almost 80% of people, compared with ciprofloxacin's 10%. The authors say that a single dose of ciprofloxacin may be too low a threshold for V cholerae, 01 strain.

    Maori people get poorer hospital care

    Maori people, New Zealand's large indigenous minority, have previously been reported to have disadvantaged health status compared with the rest of the population. It is notoriously hard to distinguish, however, whether differences in the quality of care between ethnic groups result from discrimination by the system and staff or from other variations, such as access, appropriateness of treatment, or patients' choice.

    A recent …

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