Cholera Treatment: Managing Symptoms and Preventing Dehydration

Cholera is an acute secretory diarrheal illness caused by Vibrio cholerae toxin. There is no specific "cure" that kills the bacteria instantly; treatment is entirely supportive, centered on aggressive fluid and electrolyte replacement.

Cornerstone: Rehydration Therapy

Oral Rehydration Solution (ORS)

WHO reduced-osmolarity ORS (75 mEq/L Na⁺, 75 mmol/L glucose, 20 mEq/L K⁺, 30 mEq/L citrate, 60 mEq/L Cl⁻) is the global standard.

• Mild/moderate dehydration: ORS alone, 50–100 mL/kg over 4 hrs, then maintenance.
• Severe dehydration/shock: IV fluids first (Ringer's lactate preferred), then switch to ORS when alert.
• Ongoing losses: Replace stool volume mL-for-mL with ORS.

Intravenous Fluids

Ringer's lactate (Hartmann's) is ideal (physiological pH, lactate → bicarbonate). Normal saline causes hyperchloremic acidosis. Give 30 mL/kg bolus, repeat until perfusion restored.

Adjunctive Therapies

• Antibiotics (reduce duration/volume by ~50%): Doxycycline 300 mg single dose (adults), azithromycin 1 g (children/pregnant), ciprofloxacin. Based on local resistance patterns.
• Zinc supplementation: 20 mg/day (children 2–59 mo) reduces duration and recurrence.
• Continue feeding: Breastfeeding, age-appropriate diet; do not withhold food.

Prevention

• Safe water, sanitation, hygiene (WASH)
• Oral cholera vaccines (OCV): killed whole-cell (Shanchol, Euvichol) — 2 doses, ~65% efficacy for 3–5 years.

Outcome

With prompt rehydration, case fatality <1%. Without treatment, fatality 25–50%.