What is the role of medications in the treatment of Vibrio infections?

Updated: Jun 21, 2021
  • Author: Hoi Ho, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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In adults with noncholera Vibrio infections other than gastroenteritis, the combination of a third-generation cephalosporin (eg, ceftazidime, cefotaxime, ceftriaxone) and tetracycline or one of its analogues (eg, doxycycline) or a single-agent regimen with a fluoroquinolone (eg, levofloxacin, ciprofloxacin) is the therapy of choice. [53, 54]

Among children with serious noncholera Vibrio infections in whom tetracycline and fluoroquinolone are contraindicated, trimethoprim-sulfamethoxazole plus an aminoglycoside (eg, gentamicin) is recommended. [53]

Analyzing the efficacy of 3 antibiotic regimens (group 1, a third-generation cephalosporin; group 2, a third-generation cephalosporin plus minocycline; group 3, a fluoroquinolone with or without minocycline) in terms of patient outcomes in the treatment of 89 cases of V vulnificus necrotizing fasciitis, authors reported that a fluoroquinolone or the combination of a third-generation cephalosporin plus minocycline are antibiotics of choice in lowering mortality rates (61% in group 1 vs 14% in group 2; P = 0.0003; 61% in group 1 vs 14% in group 3; P = 0.00027). [55]

Another alternative regimen with documented synergism in an in vivo study on mice is cefotaxime and minocycline. [56]

In a retrospective chart review of 93 patients hospitalized with serious Vibrio infections, the combination of a third-generation cephalosporin and tetracycline or its analogue was an independent factor for lower mortality (odds ratio,  0.037; P < .001). [37]

A recent study done in Republic of Korea on 218 subjects with V. vulnificus septicemia showed the 30-day survival rate of the third-generation cephalosporin (TGC) plus doxycycline group was not statistically different from that of the TGC plus ciprofloxacin group (38% vs.54%, P = 0.18). There was no significant difference in survival rate between the TGC monotherapy and TGC plus doxycycline groups (P = 0.76). [57]

Tigecycline, a novel glycylcycline, has a potent in vitro antimicrobial effect against Vibrio species. The efficacy of tigecycline in combination with cefpirome has been highlighted as "salvage" therapy in a child with V. vulnificus necrotizing fasciitis who was not clinically responding to ceftazidime and minocycline. [58] The survival rate in mice treated with the combination of tigecycline and ciprofloxacin was significantly higher than those treated with the combination of cefotaxime and minocycline (71% vs 42%; log-rank test, P = 0.04). [59]

Other newer antibiotics such as daptomycin and linezolid that were approved for the treatment of serious skin and soft-tissue infections have not been studied in serious Vibrio infections. Therefore, the authors do not recommend the use of these antibiotics in the treatment of serious Vibrio infections.

Adjuvant therapy: Recombinant human activated protein C (drotrecogin alfa activated) has been used as an adjuvant therapy in patients with severe sepsis who scored 25 or more on the Acute Physiology and Chronic Health Evaluation (APACHE II). A few patients with V vulnificus sepsis who were successfully treated with antibiotics, surgical debridement, and recombinant human activated protein C were reported. In view of serious bleeding associated with the continuous infusion of recombinant human activated protein C and the potential requirement for repeated surgical debridement in patients with V vulnificus sepsis, routine use of this adjuvant therapy is not recommended. [60]

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