Summary
Cholera is a dramatic clinical illness that requires rapid diagnosis and aggressive therapy. Clinical signs and symptoms of mild, moderate and severe dehydration must be determined, before beginning fluid therapy. Fluid therapy has 2 phases: rehydration (first 3 to 4 hours to correct deficits) and maintenance (to match continuing losses). The route and speed of fluid administration will depend on the degree of dehydration. Patients with severe dehydration should be treated intravenously, as should thpse patients who do not tolerate oral rehydration solution (ORS). Ringer’s lactatje is the preferred intravenous solution, although normal saline may be used alohg with ORS. For most patients with cholera, an ORS using one of the higher sodium-containing solutions and plain water optimally provide the fluid and salt needed. Close monitoring of intake, outputs and hydration status should be performed for all patients. Antimicrobial therapy should be given to moderately and severely ill patients in order to decrease the volume of fluids lost and to shorten the period of excretion of vibrios.
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References
Albert MJ, Ansaruzzaman M, Bardhan PK, et al. Cholera Working Group, International Centre for Diarrhoeal Diseases Research, Bangladesh. Large epidemic of cholera-like disease in Bangladesh caused by Vibrio cholerae 0139 synonym Bengal. Lancet 1993; 342 (8868): 387–90
Wachsmuth IK, Evins GM, Fields PI, et al. The molecular epidemiology of cholera in Latin America. J Infect Dis 1993; 167: 621–6
Swerdlow DL, Ries AA. Vibrio cholerae non 01 — the eighth pandemic?. Lancet 1993; 342: 382–3
Cholera in 1991. Wkly Epidemiol Rec 1992; 67: 253-60
Bennish ML. Cholera: pathophysiology, clinical features, and treatment. In: Wachsmuth K, Blake PA, Olsvik Æ, editors. Vibrio cholerae and cholera: molecular to global perspectives. Washington, DC: American Society for Microbiology, 1994: 229–55
Gangarosa EJ, Mosley WH. Epidemiology and surveillance of cholera. In: Barua D, Burrows W, editors. Cholera. Philadelphia: Saunders, 1974: 381–403
Battacharya SK, Battacharya MK, Nair GB, et al. Clinical profile of acute diarrhoea cases infected with the new epidemic strain of Vibrio cholerae 0139: designation of the disease as cholera. J Infect 1993; 27: 11–5
Cieza J, Gamarra G, Torres C, et al. Expansion endovenosa rapida con cloruro de sodio al 0.9% en pacientes adultos moderada y severamente deshidratados por colera. Rev Med Herediana 1991; 2: 57–63
Gotuzzo E, Cieza J, Estremadoyro L, et al. Cholera: lessons from the epidemic in Peru. Infect Dis Clin North Am 1994; 8: 183–205
Rabbani GH, Greenough III WB. Pathophysiology and clinical aspects of cholera. In: Barua D, Greenough III WB, editors. Cholera. New York: Plenum Medical Book Co., 1992: 209–28
Miyahira J, Acosta R, Zurita S, et al. Insuficiencia renal aguda en el Hospital Nacional Cayetano Heredia. Rev Med Herediana 1991; 2: 64–9
Cieza J. Esquema para el manejo de pacientes deshidratados por colera. Rev Med Herediana 1991; 2: 85–8
World Health Organization. Management of the patient with cholera. Geneva: World Health Organization, Programme for Control of Diarrhoeal Disease, 1991. Publication WHO/CDD/SER/91.15, 1991
Kaper JB, Morris JG, Levine MM. Cholera. Clin Microbiol Rev 1995; 8: 48–86
Fukuda JM, Yi A, Chaparro L, et al. Clinical characteristics and risk factors for Vibrio cholerae infection in children. J Pediatr 1995; 126: 882–6
Hirschhorn N, Greenough III WB. Progress in oral rehydration therapy. Sci Am 1991; 264: 50–6
Gore SM, Fontaine O, Pierce NF. Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta analysis of 13 clinical trials. BMJ 1992; 304: 287–91
Greenough III WB, Gordon RS, Rosenberg IS, et al. Tetracycline in the treatment of cholera. Lancet 1964; I: 355–7
Alam AN, Alam NH, Ahmed T, et al. Randomised double blind trial of single dose doxycycline for treating in adults. BMJ 1990; 300: 1619–21
Mhalu FS, Mmari PW, Ijumba J. Rapid emergence of El Tor Vibrio cholerae resistant to antimicrobial agents during first six months of fourth cholera epidemic in Tanzania. Lancet 1979; I: 345–7
Glass RI, Huq Y, Alim AR, et al. Emergence of multiple antibiotic-resistant Vibrio cholerae in Bangladesh. J Infect Dis 1980; 142: 939–42
Battacharya SK, Bhattacharya MK, Dutta P, et al. Double-blind randomized, controlled clinical trial of norfloxacin for cholera. Antimicrob Agents Chemother 1990; 34: 939–40
Gotuzzo E, Seas C, Echevarria J, et al. Ciprofloxacin for the treatment of cholera: a randomized, double-blinded, controlled clinical trial of a single daily dose in Peruvian adults. Clin Infect Dis 1995; 20: 1485–90
Ghosh S, Sengupta PG, Gupta DN, et al. Chemoprophylaxis studies in cholera: a review of selective works. J Commun Dis 1992; 24: 55–7
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Seas, C., DuPont, H.L., Valdez, L.M. et al. Practical Guidelines for the Treatment of Cholera. Drugs 51, 966–973 (1996). https://doi.org/10.2165/00003495-199651060-00005
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DOI: https://doi.org/10.2165/00003495-199651060-00005