Cholera medical therapy: Difference between revisions
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* Try to compensate for loss of potassium (for example, eat bananas or drink green coconut water) | * Try to compensate for loss of potassium (for example, eat bananas or drink green coconut water) | ||
===Antibiotics=== | ===Antibiotics=== | ||
* [[Antibiotic]] treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms.<ref name=Lancet2004/> People will recover without them, however, if sufficient hydration is maintained. | * [[Antibiotic]] treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms.<ref name=Lancet2004/> People will recover without them, however, if sufficient hydration is maintained. | ||
* Testing for resistance during an outbreak can help determine appropriate future choices. | * Testing for resistance during an outbreak can help determine appropriate future choices. Other antibiotics proven to be effective include [[cotrimoxazole]], [[erythromycin]], [[tetracycline]], [[chloramphenicol]], and [[furazolidone]].<ref>{{cite web |url=http://sprojects.mmi.mcgill.ca/tropmed/disease/chol/treatment.htm |title=Cholera treatment|publisher=Molson Medical Informatics |year=2007 |accessdate=2008-01-03}}</ref> [[Fluoroquinolone]]s, such as [[norfloxacin]], also may be used, but resistance has been reported.<ref>{{cite journal |author=Krishna BV, Patil AB, Chandrasekhar MR |title=Fluoroquinolone-resistant Vibrio cholerae isolated during a cholera outbreak in India |journal=Trans. R. Soc. Trop. Med. Hyg. |volume=100 |issue=3 |pages=224–6 |year=2006 |month=March |pmid=16246383 |doi=10.1016/j.trstmh.2005.07.007 |url=http://linkinghub.elsevier.com/retrieve/pii/S0035-9203(05)00237-3 |ref=harv}}</ref> | ||
* In many areas of the world, [[antibiotic resistance]] is increasing. In [[Bangladesh]], for example, most cases are resistant to tetracycline, [[trimethoprim-sulfamethoxazole]], and erythromycin.<ref name=NEJM2006/> Rapid diagnostic assay methods are available for the identification of multiple drug-resistant cases.<ref name="Mackay"> {{cite book| author = Mackay IM (editor)| title = Real-Time PCR in microbiology: From diagnosis to characterization| publisher = Caister Academic Press| year = 2007| isbn=978-1-904455-18-9}}</ref> New generation antimicrobials have been discovered which are effective against in ''in vitro'' studies.<ref name="Ramamurthy">{{cite book| author= Ramamurthy T| year=2008| chapter=Antibiotic resistance in ''Vibrio cholerae''| title=Vibrio cholerae: Genomics and molecular biology| publisher=Caister Academic Press| isbn= 978-1-904455-33-2}}</ref> | * In many areas of the world, [[antibiotic resistance]] is increasing. In [[Bangladesh]], for example, most cases are resistant to tetracycline, [[trimethoprim-sulfamethoxazole]], and erythromycin.<ref name=NEJM2006/> Rapid diagnostic assay methods are available for the identification of multiple drug-resistant cases.<ref name="Mackay"> {{cite book| author = Mackay IM (editor)| title = Real-Time PCR in microbiology: From diagnosis to characterization| publisher = Caister Academic Press| year = 2007| isbn=978-1-904455-18-9}}</ref> New generation antimicrobials have been discovered which are effective against in ''in vitro'' studies.<ref name="Ramamurthy">{{cite book| author= Ramamurthy T| year=2008| chapter=Antibiotic resistance in ''Vibrio cholerae''| title=Vibrio cholerae: Genomics and molecular biology| publisher=Caister Academic Press| isbn= 978-1-904455-33-2}}</ref> | ||
* Doxycycline single dose 300 mg or tetracycline 12,5 mg/kg 4 time/day for 3 days | * [[Doxycycline]] is typically used first line, although some [[Strain (biology)|strains]] of ''V. cholerae'' have shown [[Antibiotic resistance|resistance]].. Doxycycline single dose 300 mg or tetracycline 12,5 mg/kg 4 time/day for 3 days | ||
* Young children: erythromycin 12,5 mg/kg 4 time/day for 3 days | * 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 below 6 months of age: 10 mg daily for 10 days add zinc | ||
Revision as of 16:10, 5 April 2012
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Cholera Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Cholera medical therapy On the Web |
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American Roentgen Ray Society Images of Cholera medical therapy |
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Risk calculators and risk factors for Cholera medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [3]
Overview
Choleria is a severe bacterial gastrointestinal, diarrheal disease. In its most severe forms, cholera is one of the most rapidly fatal illnesses known. A healthy person may become hypotensive within an hour of the onset of symptoms and may die within 2-3 hours if no treatment is provided. More commonly, the disease progresses from the first liquid stool to shock in 4-12 hours, with death following in 18 hours to several days without rehydration treatment.[1][2]
Medical therapy
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
Management of cholera patients (table 1)
| Mental status | Eyes | Thirst | Skin pinch | Conclusions | Management |
|---|---|---|---|---|---|
| Normal, Alert | Normal, hydrated | Normal | Goes down quickly (spontaneously) | No / Mild dehydration |
|
| Irritable | Sunken | Drink eagerly | Goes back slowly (< 2 sec) | Some / Moderate dehydration (in case if 2 of the symptoms are present) |
|
| Lethargic, unconscious or floppy | Sunken, absence of tears | Drinks poorly | Goes back slowly (> 2 sec) | Severe dehydration (in case if 2 of the symptoms are present) |
Total amount per day: 200 ml/kg during the first 24 hours |
Management of patients with some/moderate dehydration (table 2)
| Age | Less than 4 months | 4–11 months | 12–23 months | 2–4 years | 5–14 years | 15 years |
|---|---|---|---|---|---|---|
| Weight | Less than 5 kgs | 5–7.9 kg | 8–10.9 kg | 11–15.9 kg | 16–29.9 kg | 30 kg or more |
| ORS solution in ml | 200–400 | 400–600 | 600–800 | 800–1200 | 1200–2200 | 2200–4000 |
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.[3] People will recover without them, however, if sufficient hydration is maintained.
- Testing for resistance during an outbreak can help determine appropriate future choices. Other antibiotics proven to be effective include cotrimoxazole, erythromycin, tetracycline, chloramphenicol, and furazolidone.[4] Fluoroquinolones, such as norfloxacin, also may be used, but resistance has been reported.[5]
- In many areas of the world, antibiotic resistance is increasing. In Bangladesh, for example, most cases are resistant to tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.[6] Rapid diagnostic assay methods are available for the identification of multiple drug-resistant cases.[7] New generation antimicrobials have been discovered which are effective against in in vitro studies.[8]
- 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
- 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
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
References
- ↑ McLeod K (2000). "Our sense of Snow: John Snow in medical geography". Soc Sci Med. 50 (7–8): 923–35. PMID 10714917.
- ↑ WHO Cholera [1]
- ↑ Invalid
<ref>tag; no text was provided for refs namedLancet2004 - ↑ "Cholera treatment". Molson Medical Informatics. 2007. Retrieved 2008-01-03.
- ↑ Krishna BV, Patil AB, Chandrasekhar MR (2006). "Fluoroquinolone-resistant Vibrio cholerae isolated during a cholera outbreak in India". Trans. R. Soc. Trop. Med. Hyg. 100 (3): 224–6. doi:10.1016/j.trstmh.2005.07.007. PMID 16246383. Unknown parameter
|month=ignored (help) - ↑ Invalid
<ref>tag; no text was provided for refs namedNEJM2006 - ↑ Mackay IM (editor) (2007). Real-Time PCR in microbiology: From diagnosis to characterization. Caister Academic Press. ISBN 978-1-904455-18-9.
- ↑ Ramamurthy T (2008). "Antibiotic resistance in Vibrio cholerae". Vibrio cholerae: Genomics and molecular biology. Caister Academic Press. ISBN 978-1-904455-33-2.