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| {{Cholera}}
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| {{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh@perfuse.org]
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| ==Overview==
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| 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.<ref name=Lancet2004/><ref name=WHOTreatmentOfDiarrhoea2005>[http://whqlibdoc.who.int/publications/2005/9241593180.pdf THE TREATMENT OF DIARRHOEA, A manual for physicians and other senior health workers], World Health Organization, 2005. See page 10 (14 in PDF) and esp chapter “5. MANAGEMENT OF SUSPECTED CHOLERA,” pages 16-17 (20-21 in PDF). 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
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| ==Medical therapy==
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| ===Summary of the treatment===
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| * Rehydrate with ORS or IV solution depending on the severity. Rehydration involves replenishment of the lost fluids and then maintenance of the fluid balance
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| * Maintain hydration and monitor frequently the hydration status
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| * Give antibiotics for severe cholera cases
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| ===Management of cholera patients (table 1)===
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| {| border="1" cellpadding="5" cellspacing="0" align="center" class="sortable"
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| |-
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| ! Mental status
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| ! Eyes
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| ! Thirst
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| ! Skin pinch
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| ! Conclusions
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| ! Management
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| |-
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| | Normal, Alert
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| | Normal, hydrated
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| | Normal
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| | Goes down quickly (spontaneously)
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| | No / Mild dehydration
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| * Child < 2 years: 50–100 ml (1/4–1/2 cup)ORS solution. Up to approximately 1/2 liter a day.
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| * Child between 2 and 9 years: 100–200 ml. Up to approximately 1 liter a day.
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| * Patient of 10 years of age or more as much as wanted, up to approximately 2 liters a day.
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| |-
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| | Irritable
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| | Sunken
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| | Drink eagerly
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| | Goes back slowly (< 2 sec)
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| | Some / Moderate dehydration (in case if 2 of the symptoms are present)
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| * Give Oral Rehydration Salt in the amount recommended in below in table 2
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| * Nasogastric tubes can be used for re-hydration when ORS solution increases vomiting and nausea or when the patient cannot drink
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| * Monitor the patient frequently
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| |-
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| | Lethargic, unconscious or floppy
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| | Sunken, absence of tears
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| | Drinks poorly
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| | Goes back slowly (> 2 sec)
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| | Severe dehydration (in case if 2 of the symptoms are present)
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| * Put an IV drip to start intravenous rehydration
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| * In case this is not possible, rehydrate with ORS
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| * Give IV drips of Ringer Lactate or if not available cholera saline (or normal saline)
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| * 100 ml/kg in three-hour period (in 6 hours for children aged less than 1 year)
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| * Start rapidly (30ml/kg within 30 min) and then slow down.
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| Total amount per day: 200 ml/kg during the first 24 hours
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| |-
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| |}
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| ===Management of patients with some/moderate dehydration (table 2)===
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| {| border="1" cellpadding="5" cellspacing="0" align="left" class="sortable"
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| |-
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| ! Age
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| ! Less than 4 months
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| ! 4–11 months
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| ! 12–23 months
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| ! 2–4 years
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| ! 5–14 years
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| ! 15 years
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| |-
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| ! Weight
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| | Less than 5 kgs
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| | 5–7.9 kg
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| | 8–10.9 kg
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| | 11–15.9 kg
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| | 16–29.9 kg
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| | 30 kg or more
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| |-
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| ! ORS solution in ml
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| | 200–400
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| | 400–600
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| | 600–800
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| | 800–1200
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| | 1200–2200
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| | 2200–4000
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| |}
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| ===Maintenance of hydration & monitoring the patient===
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| Reassess the patient for signs of dehydration regularly during the first six hours:
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| * Number and quantity of stools and vomit in order to compensate for the loss of body fluids
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| * Radial pulse: if it remains weak, IV rehydration has to be continued.
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| ===Method to prepare home made ORS solution===
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| * If ORS sachets are available: dilute one sachet in one litre of safe water
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| * Otherwise: Add to one litre of safe water:
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| ** Salt 1/2 small spoon (2.5 grams)
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| ** Sugar 6 small spoons (30 grams)
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| * Try to compensate for loss of potassium (for example, eat bananas or drink green coconut water)
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| ===Antibiotics===
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| * [[Antibiotic]] treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms.
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| * People can recover even without them, if sufficient hydration and electrolyte balance is maintained.
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| * [[Doxycycline]] is typically used first line, although some [[Strain (biology)|strains]] of ''V. cholerae'' have shown [[Antibiotic resistance|resistance]].
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| * Doxycycline single dose 300 mg or tetracycline 12,5 mg/kg 4 time/day for 3 days
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| * 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>
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| * [[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>
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| * Young children: erythromycin 12,5 mg/kg 4 time/day for 3 days
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| ** for children below 6 months of age: 10 mg daily for 10 days add zinc
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| ** for children 6 months to 5 years of age: 20mg daily for 10 days add zinc
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| * 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.<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>
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| ===Nutrition===
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| * 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.
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| * Provide frequent small meals with familiar foods during the first two days rather than infrequent large meals
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| * Breastfeeding of infants and young children should continue
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| == References ==
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| {{Reflist|2}}
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| == External links ==
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| [[Category:Neurotoxins]]
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| [[Category:Pandemics]]
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