Cholera medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]

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^[1][2]. 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^[3]. People can recover even without them, if sufficient hydration and electrolyte balance is maintained. Doxycycline is typically used first line^[4], although some strains of V. cholerae have shown resistance^[5]. Zinc supplementation has been shown to reduce stool output and reduces the duration and severity of symptoms.^[6]

• Rehydrate with ORS or IV solution depending on the severity. Rehydration involves replenishment of the lost fluids and then maintenance of the fluid balance ^[1][2]
• Maintain hydration and monitor frequently the hydration status^[1][2]
• Give antibiotics for severe cholera cases^[7]
• Zinc supplementation for reduction of stool output and improvement of symptom duration and severity^[6]

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 must be continued.

• 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)

• 1. WHO ^{[8] [9]}

• Note: Antibiotic treatment for cholera patients with severe dehydration only
• Adults

• Preferred regimen: Doxycycline 300 mg po single dose
• Alternative regimen: Tetracycline 12.5 mg/kg PO qid for 3 days

• Pediatric

• Under 12 years old

• Preferred regimen: Erythromycin 12.5 mg/kg PO qid for 3 days

• Over 12 years old

• Preferred regimen: Doxycycline 300 mg po single dose
• Alternative regimen: Tetracycline 12.5 mg/kg PO qid for 3 days

• 2. Pan American Health Organization ^[10]

• Note: Antibiotic treatment for cholera patients with moderate or severe dehydration
• 2.1 Adult

• Preferred regimen: Doxycycline 300 mg po single dose
• Alternative regimen (1): Ciprofloxacin 1 g PO single dose
• Alternative regimen (2): Azithromycin 1 g PO single dose

• 2.2 Pediatric

• 2.2.1 Children over 3 year, who can swallow tablets

• Preferred regimen (1): Erythromycin 12.5 mg/kg/ PO qid for 3 days
• Preferred regimen (2): Azithromycin 20 mg/kg PO in a single dose
• Alternative regimen (1): Ciprofloxacin suspension or tablets 20 mg/kg PO single dose
• Alternative regimen (2): Doxycycline suspension or tablets 2-4 mg/kg PO single dose
• Note: Although doxycycline has been associated with a low risk of yellowing of the teeth in children, its benefits outweigh its risks

• 2.2.2 Children under 3 year, or infants who cannot swallow tablets

• Preferred regimen (1): Erythromycin suspension 12.5 mg/kg/ PO qid for 3 days
• Preferred regimen (2): Azithromycin suspension 20 mg/kg PO single dose
• Alternative regimen (1): Ciprofloxacin suspension 20 mg/kg PO single dose
• Alternative regimen (2): Doxycycline syrup 2-4 mg/kg PO single dose

• 2.3 Pregnancy

• Preferred regimen (!): Erythromycin 500 mg/ PO qid for 3 days
• Preferred regimen (2): Azithromycin 1 g PO single dose

• Proper attention to nutrition is particularly 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 the pediatric 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.

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