SHANCHOL

Indications

• Cholera
• Severe dehydration due to cholera
• Preventive measures in endemic areas
• Post-exposure prophylaxis in outbreak situations

Dosage

Children: Refer to clinical guidelines for specific antibiotic treatment for cholera in children, ensuring appropriate dosing based on weight and severity of the disease.

Adults: Refer to clinical guidelines for specific antibiotic treatment for cholera, taking into account the severity of the disease and local resistance patterns.

Mechanism of action

Vibrio cholerae produces cholera toxin, an enterotoxin that binds to the GM1 ganglioside receptor on intestinal epithelial cells. Once internalized, the toxin activates adenylate cyclase, leading to increased levels of cyclic AMP (cAMP) within the cell. Elevated cAMP levels result in the secretion of electrolytes and water into the intestinal lumen, causing the characteristic watery diarrhea associated with cholera.

Pharmacodynamics

The pharmacodynamic effects of cholera toxin include increased intestinal secretion of fluid and electrolytes, leading to hypersecretion and diarrhea. It is also noted for its potential to induce a strong inflammatory response, altering gut motility and absorption.

Pharmacokinetics

Cholera toxin does not have traditional pharmacokinetics like drugs; rather, its effects are localized to the intestinal lumen. It acts rapidly upon entry into the intestinal cells, with effects seen in minutes. The duration of action tends to correlate with the persistence of the toxin and the host's immune response.

Pregnancy

Cholerae vaccines are generally not recommended during pregnancy unless the benefits outweigh the risks. Consult healthcare providers for individual assessment.

Breast-feeding

The vaccine is not contraindicated during breastfeeding. However, consult healthcare providers for specific recommendations.

Storage

Store cholerae vaccines in a refrigerator at 2-8 degrees Celsius. Do not freeze. Protect from light.

Formulations

• Cholera vaccine (inactivated)
• Cholera vaccine (live attenuated)

Indications

• Cholera caused by Vibrio cholerae
• Gastroenteritis caused by Vibrio parahaemolyticus
• Severe diarrhea and dehydration due to Vibrio infections
• Sepsis or other systemic infections associated with Vibrio species

Dosage

Children: Refer to the BNF for Children for appropriate dosing guidelines for paediatric

Adults: Refer to specific antibiotic guidelines for treatment of Vibrio infections, as dosing varies based on the antibiotic used and severity of the infection.

Mechanism of action

Vibrio cholerae secretes cholera toxin, which activates adenylate cyclase in intestinal epithelial cells, leading to increased levels of cyclic AMP (cAMP). Elevated cAMP levels result in the secretion of electrolytes and water into the intestinal lumen, causing diarrhea and dehydration. Other Vibrio species may have different pathogenic mechanisms, including the production of enterotoxins or adherence factors that facilitate colonization in the gut.

Pharmacodynamics

The pharmacodynamics of antibiotics used against Vibrio infections generally involve bactericidal or bacteriostatic effects, depending on the class of antibiotic used. Commonly prescribed antibiotics may inhibit bacterial cell wall synthesis, protein synthesis, or nucleic acid synthesis, leading to the death of the bacteria or inhibition of their growth. The effectiveness of treatment can be influenced by the antibiotic susceptibility profile of the specific Vibrio strain.

Pharmacokinetics

The pharmacokinetics of antibiotics used for Vibrio infections can vary widely. For instance, drugs such as doxycycline and azithromycin are often used, with doxycycline exhibiting good oral bioavailability and a half-life that allows for once or twice daily dosing. Azithromycin has a long half-life and good tissue penetration, which may enhance its effectiveness in treating bacterial infections. The distribution, metabolism, and excretion of these drugs are crucial in determining their dosing schedules and duration of therapy.

Pregnancy

No specific data available. Safety during pregnancy should be considered on a case-by-case basis, weighing potential benefits against risks.

Breast-feeding

Safety during breastfeeding is not well established; caution is advised.

Storage

Store in a cool, dry place, away from direct sunlight.