- Stool specimens or rectal swabs should be sent to the laboratory in a transport medium (e.g. CB medium, VR medium, Alkaline Peptone water).
- Specimens should be collected before the patient has received any antibiotics.
- The specimen is cultured on TCBs media.
- Facilities for diagnosis are available at district and sub district laboratories.
The most important part of treatment of diarrhea, basically involves maintaining the fluid–electrolyte balance in the body. Since a lot of fluid is lost in intermittent passage of stools, the fluid and electrolytes are restored through various methods. The second part of treatment involves the stoppage/reduction in the frequency of stools.
Intravenous rehydration
Intravenous infusion is usually required only if the child is severely dehydrated. After the initial fluid and electrolyte deficit has been corrected (i.e. the signs of dehydration have gone) oral fluid should be used for maintenance therapy.
Breast Feeding during Diarrhea
If the diarrhea is mild (few watery bowel movements), then breast feeding should not be withheld.
Not only does breast milk help the infant to recover from an attack of diarrhea both in terms of the nutrients if supplied, and its rehydrating effect, but it helps to prevent further infection because it has protective properties.
Antibiotics and diarrhea
Antibiotics should not be routinely prescribed in the treatment of diarrhea. They are useful in certain specific conditions such as typhoid, cholera, and shigella diarrheas. It is possible that they may do harm .For e.g. neomycin can damage the intestine lining and cause malabsorption.
Role of Anti–motility Agents
Anti–motility agents such as loperamide, tincture opium, should not be used to control diarrhea. They may slow down the intestinal motility and give more time for the replication of the organisms. On the other hand, agents to purge the gastrointestinal tract also should not be used as it may make the diarrhea worse. Other anti–diarrheal agents such as kaolin, pectin also are generally not useful.
Home Remedies
If the WHO mixture of salts is not available, a simple mixture consisting of table salt (5g) and sugar (20g) dissolved in one liter of drinking water may be safely used until the proper mixture is obtained.
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).
| 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.
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.
Incubation Period
Incubation period varies from a few hours to 5 days, usually 2–3 days