Cholera

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Case Definition

Rice water diarrhoea with or without vomiting, causing severe dehydration or death.

  • In suspected cases (below), notify Provincial Medical Director immediately.
  • In the area, where cholera is not known to be present - a patient aged 5 and above develops severe dehydration or dies from acute watery diarrhoea
  • In the area where cholera epidemic is present a patient aged 2 years or more develops acute watery diarrhoea with or without vomiting
  • Every child in cholera affected area who presents with acute watery diarrhoea with/without vomiting and has signs of some/severe dehydration - Collect stool samples for confirmation.

For confirmation at the beginning of an outbreak, take rectal swab or stool specimen, handle properly and transport carefully to laboratory. Treat on site without referral wherever possible.

Incubation period: commonly 2-4 days (range 1-7 days).

Management: Rehydration is the most important step- orally in moderate cases, IV (using Ringer lactate) in more severe cases.

Quick Identification of Cholera Cases Using Standard Case Definition

A patient who is suffering from acute watery or rice watery diarrhoea with or without vomiting and with signs of dehydration and is above 2 years of age should be suspected as a case of cholera during an outbreak. (In an Epidemic children below 2 years can also be affected). Acute watery diarrhoea - passage of watery or liquid stools ≥3 times in last 24 hours.

Antibiotics in a Cholera Epidemic

  • Antibiotics should be given to all cases of severe dehydration
  • The choice of antibiotics depends on local sensitivity pattern

First line medicine (except in pregnancy):

  • For adults
Medicine  Adult Dose   Frequency  Duration
ciprofloxacin po 1g single dose after correction of severe dehydration
  • For children
Medicine  Paed Dose   Frequency  Duration
ciprofloxacin po 20mg/kg  single dose after cessation of vomiting (if any)

Second line medicine:

  • For adults:
Medicine  Adult Dose   Frequency  Duration
azithromycin po  1g  single dose  after correction of severe dehydration
  • For children:
Medicine  Adult Dose   Frequency  Duration
azithromycin po  20mg/kg  single dose after cessation of vomiting (if any) 

Alternative medicine (Except in pregnancy)

Medicine  Adult Dose   Frequency  Duration
doxycycline po  300mg  single dose  =after food 
  • In Pregnancy: 

Medicine

Adult dose

Frequency

Duration

erythromycin po

500mg

6 hrly

3 days

for all only if sensitive

Medicine Paed dose Frequency Duration
erythromycin po  12.5mg/kg 6 hrly 3 days

Acute Intestinal Disease - Amoebic Dysentery

Medicine Adult dose Frequency Duration
metronidazole po

800mg

(Paed = 10mg/kg)

 3 times a day 5 days