July 23, 2016
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Cholera (cont.)

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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:

WHO Fluid Replacement or Treatment Recommendations (as per the CDC)
Patient conditionTreatmentTreatment volume guidelines; age and weight
No dehydrationOral 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 dehydrationOral 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 dehydrationIV drips of Ringer Lactate or, if not available, normal saline and oral rehydration salts as outlined aboveAge < 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)
  • Ampicillin
  • 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.

Medically Reviewed by a Doctor on 6/16/2016

Source: MedicineNet.com
http://www.medicinenet.com/cholera/article.htm

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