New evidence of drug resistance observed in an outbreak of Cholera in Kumasi, Ghana 2012

Cholera remains of great public health concern in developing countries. There is limited, yet convincing evidence of multi-drug resistant Cholera in Ghana.In an effort to continue documentation of resistance trends in Ghana, we present this recent clinically observed evidence of resistance to commonly used antibiotics. Currently, three antibiotics are recommended for treatment of Cholera per national guidelines; Tetracycline, Doxycycline and Erythromycin.The Ashanti Region is the most populated region in Ghana accounting for nearly 20% of the 25 million Ghanians. Kumasi houses the Komfo Anokye Teaching Hospital (KATH), the only national referral center in the region. Various environmental and sanitation conditions in the region are conducive for cholera transmission.Between the 24th November and 26th December 2012, the hospital recorded 26 suspected cases of Cholera. All patients presented with a history of profuse non-bloody, non-mucoid, watery diarrhea. A polyvalent serum was used to determine the serotypes of V. cholerae. Sixteen unique samples were sent for microbiologic investigation. Nine samples (56.3%) had V. cholera isolated with corresponding serotypes being Ogawa (n=8) and Inaba (n=1). Sensitivity patterns observed for routine antibiotics were 50% resistance for Erythromycin (n=2); 50% for Tetracycline(n=8); Ciprofloxacin 0% (n=9); Ceftriaxone 0% (n=8) and Cefuroxime 56% (n=8). The observed resistance challenges current national guidelines on antibiotic therapy for cholera.These data highlight potential for Ciprofloxacin use in future Cholera outbreaks in the region.Preventive measures notwithstanding, this small outbreak calls for capacity-building in large-scale molecular techniques for outbreak response. KATH is the only public institution regionally, and one of few nationally, capable of conducting antibiotic sensitivity testing.