Prompt & adequateReplacement of water & electrolytes is
very important. It may be given orally or Intravenously.
Clinical Management
Early treatment, in most cases by oral rehydration therapy, can reduce
the case fatality of cholera to less than 1%. If treatment is delayed
or inadequate, death from dehydration and circulatory collapse may
follow rapidly.
A. Oral Rehydration Therapy - For mild cases Oral Rehydration Salt
is recommended
· Recommended ORS solution -WHO formula
Compostion of ORS
(net weight = 27.9gm)
ORS is available in powder form , in following composition which
is recommended by WHO. The powder is to be dissolved in one litre
of water & given
orally as per schedule given in table :-
sr no
Ingredient
Weight (gm)
1
Sodium Chloride IP
3.5
2
Potassium Chloride IP
1.5
3
Sodium citrate IP
2.9
4
Glucose anhydrous IP
20.0
ORS packets are available at all subcentres, PHCs and other hospitals.
Depot holders are established at villages & Padas in Tribal area.
The age-wise requirement of ORS is as follows :-
The ORS schedule is of 4 hours
Age
Dose
0-6 months
250 ml(1/4 litre)
6 months to 1 year
500 ml(1/2 litre)
1 year to 2 year
750 ml(3/4 litre)
2 years to 5 years
1 litre
5 years to 15 years
1 to 2 litres
Above 15 years
2 to 4 litres
· If the patient is thirsty and wants to drink more, allow
to drink.
· After rehydration has been achieved, continue giving ORS
solution for replacement of ongoing losses. Plain water and home
available fluids can be taken.
Signs of dehydration are to be checked until they subsides.
Introduction of ORS has reduced cost of treatment & is very effective
way to reduce morbidity & mortality due to dehydration.
Development of Oral rehydration therapy is a major breakthrough in
the fight against cholera and other diarrhoeal diseases.
B. Intravenous Therapy - For sever cases of cholera I.V. infusion
of fluid & electrolyte is required .
Age wise requirement of I.V. Infusion
Age Group
Quantity required
Frequency (Timing)
Infants
30 ml /kg body weight
70 ml/kg body weight
1st hour
Next five hours
Older Children / Adults
30 ml /kg body weight
70 ml / kg body weight
1st 30 min
next 2 & half hours
Recommended Fluid Therapy
·
Preferred: Ringer lactate solution
·
Suitable: Normal Saline (does not correct base acodosis and potassium
losses)
·
Unsuitable: Plain glucose(dextrose) solution.
Antibiotic Therapy
Antibiotics are to be given as soon as vomiting has stopped- which
is usually 3-4 hours of oral rehydration.
The drug of choice for treatment is ;-
Antibiotic
Children
Adults
Preferred to
Doxycycline (once)
-
300 mg
adult
Tetracycline (4 times a day for 3 days)
12.5 mg /kg
500 mg
adult
Trimethroprim (TMP)Sulfamethoxazole (SMX) twice a day for 3
days
TMP 5 mg/kg SMX 25 mg/kg
TMP 160 mg SMX 800 mg
Children
Furazoludine 4 times a day for 3 days
1.25 mg/kg
100 mg
Pregnant woman
· Injectable antibiotics have no special advantageous.
·
No other medications, antispasmotics antidiarrhoeal cardiolotrics
are required. If diarrhoea persists after 48 hours of treatment resistance
to antibiotics should be suspected & antibiotics are to be prescribed
accordingly.
Maintenance therapy
After the initial fluid and electrolyte deficit has been corrected
. Oral fluid should be used for maintenance therapy. In adults and
older children , thirst is an adequate guide for fluid needs. The
Oral fluid intake should equal the rate of continuing stool loss.
