A 2-year-old is brought with acute watery diarrhea. The stool is 'rice-water' in character, odorless, and the child has severe dehydration. Stool microscopy shows comma-shaped organisms, and vibrio toxin enzyme immunoassay is positive. The child is given intravenous Ringer's lactate. Once she can take orally, which antibiotic should be added to reduce illness duration?

• A Oral amoxicillin for 5 days
• B Ciprofloxacin for 3 days
• C Oral cotrimoxazole for 5 days
• D A single dose of oral doxycycline (not in children <8 years — use azithromycin) ✓

Explanation

The case describes cholera (Vibrio cholerae). In children below 8 years of age, doxycycline (the drug of choice for adults) is contraindicated due to dental staining. In children, azithromycin (20 mg/kg as a single dose) is the preferred antibiotic for cholera. Ciprofloxacin is an alternative. Rehydration remains the cornerstone of management. Antibiotics reduce the duration of diarrhea and vibrio excretion but are adjunctive.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.