Cholera Treatment: Oral Rehydration, IV Fluids, Antibiotics & Supportive Care

Cholera Management: WHO Guidelines

Cholera (Vibrio cholerae O1/O139) causes profuse watery diarrhea ("rice-water stools") → rapid dehydration, electrolyte depletion, death if untreated.

1. Oral Rehydration Solution (ORS) – Cornerstone

• WHO ORS formula: NaCl 2.6g, Na citrate 2.9g, KCl 1.5g, Glucose 13.5g / 1L water
• Mechanism: Glucose-Na⁺ cotransport (SGLT1) drives water absorption
• Dosing: 50–100 mL/kg in first 4 hrs (rehydration), then 10–20 mL/kg per stool (maintenance)
• Advantages: Low-cost, no IV access needed, can be given at home

2. Intravenous Fluids – Severe Dehydration / Shock

• Indications: Severe dehydration (>10% BW loss), shock, vomiting preventing ORS, altered mental status
• Fluids: Ringer's Lactate / Hartmann's (preferred); Normal Saline alternative
• Rate: 100 mL/kg first 3 hrs (30 mL/kg in 30 min, then 70 mL/kg in 2.5 hrs) adults; adjust for children
• Transition to ORS as soon as patient can drink

3. Antibiotics – Adjunctive

• Indications: Severe cases; high stool volume; reduce shedding duration
• First-line: Doxycycline 300 mg single dose (adults); Azithromycin 20 mg/kg (children, pregnancy)
• Alternatives: Ciprofloxacin, erythromycin, tetracycline
• NOT for prophylaxis – drives resistance

4. Zinc Supplementation (Children)

• 20 mg/day × 10–14 days → reduces stool volume/duration, prevents recurrence

5. Supportive Care

• Continue feeding (breastfeed, age-appropriate diet) – never starve
• Hygiene/sanitation to prevent spread
• Surveillance for complications (hypoglycemia, renal failure, electrolyte imbalance)

Prevention

• Safe water, sanitation, hygiene (WASH)
• Oral cholera vaccines (OCV): Dukoral, Shanchol, Euvichol – 2 doses, ~65% efficacy 2–5 yrs

ORS saves lives. 90% of cholera deaths are preventable with timely rehydration.