Cholera medical therapy


 * Associate Editors-In-Chief: Priyamvada Singh, MBBS [mailto:psingh@perfuse.org]

Overview
In most cases, cholera can be successfully treated with oral rehydration therapy (ORT), which is highly effective, safe, and simple to administer. In severe cases with significant dehydration, intravenous rehydration may be necessary. Ringer's lactate is the preferred solution, often with added potassium. Large volumes and continued replacement until diarrhea has subsided may be needed. Ten percent of a person's body weight in fluid may need to be given in the first two to four hours. Antibiotic treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms. People can recover even without them, if sufficient hydration and electrolyte balance is maintained. Doxycycline is typically used first line, although some strains of V. cholerae have shown resistance.

Summary of the treatment

 * Rehydrate with ORS or IV solution depending on the severity. Rehydration involves replenishment of the lost fluids and then maintenance of the fluid balance
 * Maintain hydration and monitor frequently the hydration status
 * Give antibiotics for severe cholera cases

Maintenance of hydration & monitoring the patient
Reassess the patient for signs of dehydration regularly during the first six hours:
 * Number and quantity of stools and vomit in order to compensate for the loss of body fluids
 * Radial pulse: if it remains weak, IV rehydration has to be continued.

Method to prepare home made ORS solution

 * If ORS sachets are available: dilute one sachet in one litre of safe water
 * Otherwise: Add to one litre of safe water:
 * Salt 1/2 small spoon (2.5 grams)
 * Sugar 6 small spoons (30 grams)
 * Try to compensate for loss of potassium (for example, eat bananas or drink green coconut water)

Antibiotics

 * Antibiotic treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms.
 * People can recover even without them, if sufficient hydration and electrolyte balance is maintained.
 * Doxycycline is typically used first line, although some strains of V. cholerae have shown resistance.
 * Doxycycline single dose 300 mg or tetracycline 12,5 mg/kg 4 time/day for 3 days
 * Other antibiotics proven to be effective include cotrimoxazole, erythromycin, tetracycline, chloramphenicol, and furazolidone.
 * Fluoroquinolones, such as norfloxacin, also may be used, but resistance has been reported.
 * Young children: erythromycin 12,5 mg/kg 4 time/day for 3 days
 * for children below 6 months of age: 10 mg daily for 10 days add zinc
 * for children 6 months to 5 years of age: 20mg daily for 10 days add zinc
 * In many areas of the world, antibiotic resistance is increasing. Testing for resistance during an outbreak can help determine appropriate future choices. In Bangladesh, for example, most cases are resistant to tetracycline, trimethoprim-sulfamethoxazole, and erythromycin. Rapid diagnostic assay methods are available for the identification of multiple drug-resistant cases. New generation antimicrobials have been discovered which are effective against in in vitro studies.

Nutrition

 * Proper attention on nutrition is important as patients with cholera often ignore nutrition due to diarrhea and vomiting. This may lead to hypoglycemia and associated complications like seizure, coma and even death in pediatrics population.
 * Provide frequent small meals with familiar foods during the first two days rather than infrequent large meals
 * Breastfeeding of infants and young children should continue