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Cholera

This document provides guidelines for case management of cholera. It defines suspected and confirmed cholera cases and outlines steps for assessing dehydration severity. For patients with no or some dehydration, oral rehydration solution is recommended. For severe dehydration, intravenous rehydration is indicated along with antibiotics for some cases. The guidelines stress maintaining hydration and nutrition during treatment.

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Revan Nasir
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28 views

Cholera

This document provides guidelines for case management of cholera. It defines suspected and confirmed cholera cases and outlines steps for assessing dehydration severity. For patients with no or some dehydration, oral rehydration solution is recommended. For severe dehydration, intravenous rehydration is indicated along with antibiotics for some cases. The guidelines stress maintaining hydration and nutrition during treatment.

Uploaded by

Revan Nasir
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CASE MANAGEMENT FOR

CHOLERA
Case SUSPECTED CASE:
Definition • Person aged ≥2 years with acute watery diarrhea and severe dehydration or death due to acute watery diarrhea;
• When there is a confirmed cholera outbreak in the area  case definition: Any person presenting with or dying
from acute watery diarrhea.
CONFIRMED CASE: Isolation of vibrio cholera O1 or O139 from stools in any patient with diarrhea.

Is the Patient Dehydrated? There is NO SIGNS of DEHYDRATION


The patient is losing a lot of fluids because of diarrhea Give Oral Rehydration Salt Solution (ORS) after each
and/or vomiting. stool as below:
Patient shows two or more of the following signs: • Child <2 years old: give 50-100 ml (¼ - ½ cup) ORS
• Sunken eyes; NO solution, up to approximately ½ liter a day;
• Absence of tears; • Child between 2 and 9 years old: give 100-200 ml,
• Dry mouth and tongue; up to approximately 1 liter a day;
• Thirsty and drinks eagerly; • Patient of 10 years of age or more: give as much as
• Skin pinch goes back slowly. wanted, up to approximately 2 liters a day.

YES

There is SOME DEHYDRATION


Approximate amount of ORS solution to be given in
Is the Dehydration Severe? the first 4 hours:
In addition to the above signs the patient is: Age Weight ORS Solution in ml
• Lethargic, unconscious or floppy; <4 months <5 kg 200-400 ml
• Skin pinch goes back very slowly;
NO 4-11 months 5-7.9 kg 400-600 ml
• Drinks poorly or not able to drink; 12-23 months 8-10.9 kg 600-800 ml
• Radial pulse is weak. 2-4 years 11-15.9 kg 800-1200 ml
5-14 years 16-29.9 kg 1200-2200 ml
≥15 years ≥30 kg 2200-4000 ml
YES
• Nasogastric tubes can be used for rehydration when ORS
solution increases vomiting and nausea or when the
patient can not drink
In case of SEVERE DEHYDRATION • Reassess the patient for signs of dehydration regularly
during the first 6 hours.
• Put an IV drip to start intravenous rehydration;
• Refer the patient to secondary health care (if you are in the
primary health care center). ANTIBIOTICS - Only for SEVERE DEHYDRATION CASES
 Start IV drips of Ringer Lactate as following:
Which Antibiotics can be given?
‒ 100 ml/kg in 3 hours (in 6 hours for children <1 year);
• Adults: Doxycycline single dose 300 mg OR
‒ Start rapidly (30ml/kg within 30 min and within 1 hour
Tetracycline 12.5mg/kg – 4 times a day for 3 days;
for children <1 year) and then slow down.
• Young children: Erythromycin liquid 12.5 mg/kg –4
 Total amount/day: 200 ml/kg during the first 24 hours;
times a day for 3 days.
 Give ORS (about 5ml/kg/hour) as soon as the patient can
Selection of antibiotics depends on the sensitivity test.
drink, in addition to IV fluid.
 Treat the complications (e.g. renal failure) and/or
co-morbidities.

Maintain HYDRATION & MONITOR the patient Continuous provision of NUTRITIOUS FOOD
Reassess the patient for signs of dehydration regularly during Provide Nutritious Foods:
the first 6 hours: • Specially for patients with shigella dysentery;
• Number and quantity of stools and vomit in order to • As soon as the patient is able to eat; give frequent
compensate for the loss of body fluids; small meals with familiar foods in the first 2 days;
• If radial pulse remains weak continue IV rehydration.  Continue Breastfeeding for infants and young
children.

80 -90% of cholera cases can be adequately treated with ORS solution alone without intravenous therapy.
Rehydration with ORS or IV Solution depends on the dehydration severity of the patient.

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