Routine use of antimicrobial drugs during the 2004 cholera epidemic in Douala, Cameroon

Abstract

Objectives: To evaluate routine use of antimicrobial drugs for treatment and prevention of cholera with special regards to the evolution of the antimicrobial drug resistance patterns of V. cholerae strains. Design: Retrospective population-based descriptive study. Subjects: Four thousand nine hundred and forty one notified cholera cases, their 15,381 patients' guards and their 159,263 household members and close neighbours. Results: A total of 4,941 patients received antibiotic therapy according to the treatment protocols. Prophylactic treatment was administered to 15,381 patients' guards in hospitals and to 159,263 household members and close neighbours during home visits. Over the entire outbreak, the antimicrobial susceptibility patterns of V. cholerae strains isolated remained stable. Conclusions: The routine use of antimicrobial therapy for cholera cases associated with simultaneous and large scale chemoprophylaxis of close contacts does not seem in our experience to compromise the stability of V. cholerae susceptibility profiles to drugs when applied within a comprehensive package of rigorously monitored community interventions. The role of therapy and chemoprophylaxis in limiting the extent of a cholera epidemic is however difficult to ascertain from our experience. Field trials need to be designed to elucidate this aspect.