Antibiotic Resistance of Cholera in Hodeidah, Yemen 2017 versus 2024: Experimental Design

Background: Cholera, caused by Vibrio cholerae (V. cholerae), remains a significant global health threat, particularly in low- and middle-income countries (LMICs) with inadequate sanitation. The increasing emergence of antimicrobial resistance (AMR) in V. cholerae strains complicates treatment, as many commonly used antibiotics (e.g., tetracycline, doxycycline, azithromycin) become less effective. This results in treatment failures, higher morbidity and mortality, and more challenging outbreak control. Regions like Yemen reported high AMR prevalence in cholera strains. Objectives: Therefore , the study aimed to monitor the effectiveness of the antibiotics that used in treatment of cholera infection based on the inhibition zone measurements. Methods: 94 acute watery fecal samples were collected from Diarrhea Treatment Center (DTC) (isolation area) and Center of Tropical Medicine and Infectious Diseases (CTMID) of Authority of Public AL-Thawara Hospital, Hodeidah , Yemen , Outbreak , 2017 and 2024 .The V. cholerae were isolated and diagnosed based on standard microbiological methods. The resistance of antibiotics was monitored based microbiological assay in vitro. Results: The results showed that 34/94 cases (36.17%) of V. cholerae were confirmed. The clinical cholera isolates were sensitive for ciprofloxacin, doxycycline, and tetracycline were stable with the time in 2017 versus 2024 , while the resistance for azithromycin were recorded partially (50 %) in 2017 , and developed into 100 % completely in 2024. Conclusion: The study concluded that ciprofloxacin, followed by doxycycline and tetracycline, is most effective against V. cholerae. It warns against the continued use of azithromycin due to increasing resistance. The findings call for a revision of cholera treatment protocols, emphasizing the need to discontinue azithromycin and to adopt antibiotics based on local resistance patterns, clinical efficacy, and cost-effectiveness.