Table 4. Summary of international guidelines on the treatment of cholera.

Guideline	Last update		Recommendations
American Academy of Pediatrics [9]	2015		•Antimicrobial therapy should be considered for people who are moderately to severely ill •The choice of antimicrobial therapy should be made on the basis of the age of the patient as well as prevailing patterns of antimicrobial resistance
			Doxycycline 4–6 mg/kg single dose. For use in epidemics (only) caused by susceptible isolates. Not recommended for pregnant women and children <8 years
			Ciprofloxacin 15 mg/kg twice daily for 3 days. Note: decreased susceptibility to fluoroquinolones is associated with treatment failure. Ciprofloxacin is not recommended for children and pregnant women
			Azithromycin 20 mg/kg single dose
			Erythromycin 12.5 mg/kg four times a day for 3 days
			Tetracycline 12.5 mg/kg four times per day for 3 days
Therapeutic guidelines (Australia) [26]	2015		Azithromycin 20 mg/kg up to 1 g orally as a single dose
			OR
			Ciprofloxacin 20 mg/kg up to 1 g orally as a single dose
British Medical Journal ‘Best Practice’ Guidelines [25]	2017		In the event of clinical failure, treatment should be guided by susceptibility testing
			‘The correct antibiotic is chosen based on knowledge of recently isolated V. cholerae strains. In LMIC, antibiotic choice is likely to be limited by what is available in sufficient quantities to cope with high demand, and susceptibility testing is likely to take longer than the mean duration of illness, forcing empirical therapy’
			Antibiotic therapy plus zinc supplementation is recommended for ALL patient groups (encompassing mild-to-severe dehydration)
			•Azithromycin 20 mg/kg PO as a single dose
			OR
			•Tetracycline children >8 years 12.5 mg/kg PO qid for 3 days
			OR
			•Doxycycline children >8 years 6 mg/kg/day PO or IV as a single dose
			NB: In the UK, tetracyclines are not recommended for children aged ≤12 years
			OR
			•Norfloxacin 7.5 mg/kg PO bd for 3 days
			OR
			•Trimethoprim/sulfamethoxazole 4–5 mg/kg trimethoprim PO bd for 3 days
			OR
			•Ciprofloxacin 20 mg/kg PO as a single dose, or for 3 days in South Asia
			OR
			•Erythromycin base 12.5 mg/kg PO qid for 3 days
			PLUS Zinc sulphate 30 mg PO elemental zinc once daily
Centers for Disease Control (USA) [16]	2015		The authors note that ‘although the WHO recommends the use of antibiotics for severely dehydrated patients, there is an evolving consensus that moderately dehydrated patients would also benefit, especially if they have high purging rates despite initiation of appropriate treatment’
			•Antibiotics should be guided by local susceptibility patterns •‘In most countries, doxycycline is recommended as first-line treatment for adults, while azithromycin is recommended as first-line for women and children’ •‘Recently, azithromycin has been shown to be more effective than erythromycin and ciprofloxacin [4,5] and an appropriate first-line regimen for children and pregnant women.’ •Treatment with antibiotics is recommended for patients who are severely ill OR moderately dehydrated, continuing to pass a large volume of stool during rehydration treatment •Antibiotics are also recommended for all hospitalised patients
Infectious Diseases Society of America (IDSA) [22]	2001		•Doxycycline 300 mg single dose
			OR
			•Tetracycline qid for 3 days
			OR
			•TMP-SMZ 160/800 mg for 3 days
			OR
			•Single-dose fluoroquinolone
World gastroenterology guidelines [24]	2012		•Routine antimicrobial therapy is recommended for treatment of ‘clinically recognisable’ cholera. •The selection of an antimicrobial will depend on recent susceptibility of the pathogen in specific countries; in the absence of such information, susceptibility reports from neighbouring countries is the only other choice. •Doxycycline 2 mg/kg (not recommended for children) •Azithromycin 20 mg/kg as a single dose •Ciprofloxacin 15 mg/kg every 12 h for 3 days (the MIC has increased in many countries, necessitating multiple-dose therapy over 3 days) •Trimethoprim/sulfamethoxazole (TMP/SMX; 5 mg/kg TMP + 25 mg/kg SMX, 12-hourly for 3 days), and norfloxacin.
International Centre for Diarrhoeal Disease Research (ICDDR,B) [23]	1997		Antibiotics are recommended for those with ‘clinically diagnosed cholera’, not limited by severity.
			•Tetracycline 12.5 mg/kg qid for 3 days •Erythromycin 12.5 mg/kg qid for 3 days