Vibrio cholerae antimicrobial drug resistance, Papua New Guinea, 2009-2011

Abstract

Since the emergence of Vibrio cholerae in Papua New Guinea in July 2009, cholera outbreaks have been reported in several provinces causing >15,000 reported cases and nearly 500 deaths. For the treatment of cases with moderate and severe dehydration, the National Department of Health (NDoH) recommended doxycycline in adults and erythromycin in pregnant women and children. The national reference laboratory at the Port Moresby General Hospital cultured stool samples from newly detected outbreaks as well as sporadically from on-going outbreaks and tested them for antimicrobial susceptibility. Analysis of the laboratory surveillance data from 2009- 2011 revealed high levels of resistance to erythromycin (38.2% resistant, 54.7% intermediate resistant) among V. cholerae isolates. About 10% of isolates were resistant to tetracycline. Our study underscores the need for replacement of erythromycin with an alternative antibiotic for empirical treatment of moderate to severe cholera in pregnant women and children while doxycycline could still be continued for adults.