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Adjuncts to Therapy
Antibiotics should be given as soon as vomiting has stopped, which is usually after three to four hours of oral rehydration. Injectable antibiotics have no special advantages. No other medication should be given to treat cholera, like anti–diarrheas, anti–emetics, anti–spasmodic, cardio tonics and corticosteroids. Antibiotics used are tetrocycline, doxycycline Furazolidinen and Bactrim.

Sanitation Measures for Cholera
Water control: As water is the most important vehicle of transmission of cholera, all steps must be taken to provide properly treated, or otherwise safe water to the community for all purposes (drinking, washing and cooking.) In urban areas, properly treated drinking water containing residual chlorine should be made available to all families. This water should be stored in the household in narrow mouthed, covered containers. In rural areas, water can be made safe by boiling or by chlorination.

Chemoprophylaxis
Mass chemoprophylaxis is not advised for the total community in order to prevent one serious case of cholera.

Vaccination
The cholera vaccine is the only specific prophylactic available against cholera.

Dosage
Primary Immunization consists of two equal doses, injected subcutaneously, at an interval of about four to six weeks. The vaccine is not given to children under one year of age.

Reactions
Cholera inoculation is generally accompanied by local tenderness, mild swelling, even some redness, and occasionally, mild to moderate temperature elevation.

Protective Value
The protective value of currently available vaccines is estimated at about 50% for a period of about three to six months. To sum up, cholera vaccines available at present are not helpful in the control and prevention of the disease. They can be used as an adjunct to other preventive measures such as drug prophylaxis, sanitation and health education. The World Health Assembly in May 1973 abolished the requirement of a cholera vaccination certificate for international travel, although a few countries (e.g. Sudan, Libya) continue to demand such a certificate.

Health Education on Cholera
The most effective prophylactic measure is perhaps, health education. It should be directed mainly to:
  1. The effectiveness and simplicity of oral rehydration therapy.
  2. The benefits of early reporting for prompt treatment.
  3. Food hygiene practices.
  4. Hand washing after defecation and before eating.
  5. The benefit of cooked, hot foods and safe water. Since cholera is mainly a disease of the poor and ignorant, these groups should be tackled first.
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)

ORS is available in powder form, in following composition which is recommended by WHO. The powder is to be dissolved in one litre of water & given orally as per schedule given in table:
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
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 Antibiotic Therapy for Cholera
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
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.

Chemoprophylaxis
Approximately 10-12 percent of close household contacts of a cholera case may be bacteriologically positive and develop clinical illness.

Tetracycline is the drug of choice for chemprophyalaxis. It has to be given over a 3-day period in a twice -daily dose of 500mg for adults, 125mg for children aged 4-13 years and 50 mg for children aged 0-3 years.

The long acting tetracycline (doxycycline) may be used. A single oral dose of doxycycline (300 mg for adults and 6 mg/kg for children under 15 years) is effective.