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- Patient Comments: Cholera - Symptoms and Signs
- Patient Comments: Cholera - Treatments
- Cholera facts
- What is cholera?
- What is the history of cholera?
- What are cholera symptoms and signs?
- What causes cholera, and how is cholera transmitted?
- What are risk factors for cholera, and where do cholera outbreaks occur?
- Is cholera contagious?
- What is the incubation period for cholera?
- What is the contagious period for cholera?
- What physicians usually treat cholera?
- How do health-care professionals diagnose cholera?
- What is the treatment for cholera?
- Is it possible to prevent cholera? Are cholera vaccines available?
- What is the prognosis of cholera?
- Where can people find more information about cholera?
Quick GuideTravel Health: Vaccines & Preventing Diseases Abroad
What is the treatment for cholera?
The CDC (and almost every medical agency) recommends rehydration with ORS (oral rehydration salts) fluids as the primary treatment for cholera. ORS fluids are available in prepackaged containers, commercially available worldwide, and contain glucose and electrolytes. The CDC follows the guidelines developed by the WHO (World Health Organization) as follows:
|Patient condition||Treatment||Treatment volume guidelines; age and weight|
|No dehydration||Oral rehydration salts (ORS)||Children < 2 years: 50 mL-100 mL, up to 500 mL/day|
Children 2-9 years: 100 mL-200 mL, up to 1,000 mL/day
Patients > 9 years: As much as wanted, to 2,000 mL/day
|Some dehydration||Oral rehydration salts (amount in first four hours)||Infants < 4 mos (< 5 kg): 200-400 mL|
Infants 4 mos-11 mos (5 kg-7.9 kg): 400-600 mL
Children 1 yr-2 yrs (8 kg-10.9 kg): 600-800 mL
Children 2 yrs-4 yrs (11 kg-15.9 kg): 800-1,200 mL
Children 5 yrs-14 yrs (16 kg-29.9 kg): 1,200-2,200 mL
Patients > 14 yrs (30 kg or more): 2,200-4,000 mL
|Severe dehydration||IV drips of Ringer Lactate or, if not available, normal saline and oral rehydration salts as outlined above||Age < 12 months: 30 mL/kg within one hour*, then 70 mL/kg over five hours|
Age > 1 year: 30 mL/kg within 30 min*, then 70 mL/kg over two and a half hours
*Repeat once if radial pulse is still very weak or not detectable
- Reassess the patient every one to two hours and continue hydrating. If hydration is not improving, give the IV drip more rapidly. 200 mL/kg or more may be needed during the first 24 hours of treatment.
- After six hours (infants) or three hours (older patients), perform a full reassessment. Switch to ORS solution if hydration is improved and the patient can drink.
In general, antibiotics are reserved for more severe cholera infections; they function to reduce fluid rehydration volumes and may speed recovery. Although good microbiological principles dictate it is best to treat a patient with antibiotics that are known to be effective against the infecting bacteria, this may take too long a time to accomplish during an initial outbreak (but it still should be attempted); meanwhile, severe infections have been effectively treated with tetracycline (Sumycin), doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others), furazolidone (Furoxone), erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), or ciprofloxacin (Cipro, Cipro XR, ProQuin XR) in conjunction with the following antibiotics in conjunction with IV hydration and electrolytes:
- Tetracycline (Sumycin)
- Doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others)
- Furazolidone (Furoxone)
- Erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone)
- Azithromycin (Zithromax)
- Sulfamethoxazole/trimethoprim (Bactrim, Septra)
- Ciprofloxacin (Cipro, Cipro XR, ProQuin XR)
- Norfloxacin (Noroxin)
Many antibiotics are listed; however, because of widespread antibiotic resistance, including multi-resistant Vibrio strains, antibiotic susceptibility testing is advised so the appropriate antibiotic is chosen. In addition, quinolones (for example, ciprofloxacin, norfloxacin) should not be used in children if other antibiotics can be effective because of possible musculoskeletal adverse effects.