|Guidelines for Cholera Control (WHO - OMS, 1993, 68 p.)|
|6. Management of the patient with cholera|
In severe cases of cholera, antibiotics can reduce the volume and duration of diarrhoea, and shorten the period during which cholera vibrios are excreted. They can be given orally as soon as vomiting stops, usually within 3-4 hours after starting rehydration. There is no advantage in using injectable antibiotics, which are expensive.
The patients who benefit most from antibiotics are those who are severely dehydrated. Indiscriminate use of antibiotics in mild cases can quickly use up supplies and hasten the development of antibiotic resistance among cholera vibrios.
For adult cholera patients, doxycycline, a long-acting form of tetracycline, is the preferred antibiotic because only a single dose is needed. For children, paediatric tablets or liquid preparations of trimethoprim-sulfamethoxazole (TMP-SMX) are recommended. A single dose of doxycycline has not yet been shown to be effective in children. Tetracycline, however, is effective in children but in some countries is not available for paediatric use. Furazolidone, erythromycin, and chloramphenicol are other effective alternatives for adults and children. (See Table 3 of Annex 2 for antibiotics used in treating severe cholera.)
Sulfadoxine is not effective, and should not be used. A single dose can cause serious and even fatal reactions.
The choice of antibiotic should take into account local patterns of resistance to antibiotics. Knowledge of antibiotic sensitivity patterns of recent isolates in the immediate area or in adjacent areas is therefore important. Antibiotic-resistant Vibrio cholerae O1 should be suspected if diarrhoea continues after 48 hours of antibiotic treatment.
No antidiarrhoeal, anti-emetic, antispasmodic, cardiotonic, or corticosteroid drugs should be used to treat cholera. Blood transfusions and plasma volume expanders are not necessary.