Cholera

CASE DEFINITION: rice watery diarrhoea, with or without vomiting, causing severe dehydration or death

In suspected cases immediately notify the Provincial Medical Director, and obtain current cholera guidelines. See also the chapter on gastrointestinal conditions.

Rehydration is most important. The mainstay of cholera management is rehydration, intravenously or orally.

The use of antibiotics is strictly limited to very few indications such as: (i) severe dehydration (ii) high attack rate within a household or congregate settings (iii) as prophylaxis in areas described under (ii) or (iv) if specific guidance is provided as part of the cholera response. Start antibiotics after the patient is rehydrated and vomiting has stopped - usually after 4-6hrs.

Always confirm recommended medicines for the outbreak

Treatment

	Medicine	Paed Dose	Frequency	Duration
	ciprofloxacin po	20mg/kg	twice a day	3 days
or	azithromycin po	20mg/kg	single dose

Composition of fluids

Sugar Salt Solution (SSS)

6 level teaspoons of any household sugar (white or brown),

½ level teaspoon of salt (coarse salt may have to be ground fine), dissolved in 1000ml of clean water measured in any 1000ml bottle (soft drink, oil etc). [The water is boiled only if from a contaminated source and is cooled before adding ingredients.]

'Home fluids'

Any fluids including water, tea, thin porridge, 'mahewu', but avoiding cold drinks with high sugar content.

Oral Rehydration Solution: Full Formula has now been replaced with low osmolarity ORS formula.

It has low levels of glucose and salt to achieve osmolarity of 245mOsm/L resulting in improved efficacy and decreased stool output. It is safe and effective even in children with cholera.

Made in hospital pharmacies as follows:

Low osmolarity ORS

ingredient - weight

sodium chloride - 2.6g

trisodium citrate dihydrate* - 2.9g

potassium chloride - 1.5g

glucose, anhydrous - 13.5g

Water - to 1 litre

*Trisodium citrate dihydrate may be replaced by sodium bicarbonate 2.5 grams/litre.

However, ORS may be available in packets (sachets) in certain situations according to current ministry policy.

Give Zinc sulphate 20mg/day for 10-14 days with every bout of diarrhoea in infants 6 months and above. Give 10mg/day in infants below 6 months.