Management Of Cholera

Cholera is caused by Vibrio cholerae O1 and O139. Sporadic cholera cases usually occur throughout the year in endemic areas. Epidemics of cholera are also observed. This disease is transmitted mostly by faecal-oral route through contaminated water. Clinically, cholera is characterized by uncontrolled purging of watery stool leading to life-threatening dehydration, hypovolaemic shock, acidosis, and if left untreated, it can also lead to death. Asymptomatic carriers may also play a role in the spread of infection. Management of cholera without dehydration is aimed to prevent dehydration by giving more fluid than usual in the form of home-available fluids or oral rehydration salt (ORS) solution. Patient with mild dehydration can be managed with ORS solution for correction of initial dehydration and severely dehydrated patient should be treated with intravenous Ringer's lactate solution for correction of initial dehydration. After correction of initial dehydration, patient should receive "ORS" as maintenance therapy till diarrhoea stops. Antibiotics are adjunct to fluid therapy, which is recommended for the treatment of severely dehydrated cholera cases only. Oral tetracycline, azithromycin, single-dose doxycycline, and quinolone groups of drugs are usually recommended for the treatment of cholera. However, a good percentage of V cholerae strains became resistant to these drugs, hence erythromycin is recommended. Breastfeeding should not be stopped during management of cholera. Food should be reintroduced after correction of initial dehydration.