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Treatment
Prompt & adequate
Replacement 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.
Chemoprophylaxis :
Approximately 10-12 percent of close household contacts of a
cholera case may be bacteriologically positive and develop clinical
illness.
Tetracycline is the drug of choice for chemprophyalaxis. It has to
be given over a 3-day period in a twice -daily dose of 500mg for
adults, 125mg for children aged 4-13 years and 50 mg for children aged
0-3 years.
The long acting tetracycline (doxycycline) may be used. A single
oral dose of doxycycline (300 mg for adults and 6 mg/kg for children
under 15 years) is effective.
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