Cholera - Treatment

No special diet is required for cholera patients.

Treatment of cholera should follow the following basic principles:

• replenishment of fluid loss and restoration of the body's electrolyte composition;
• impact on the pathogen.

Treatment of cholera must begin within the first hours of the onset of the disease.

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Pathogenetic treatment of cholera

This treatment of cholera includes primary rehydration (replenishment of water and salt losses before the start of treatment) and corrective compensatory rehydration (correction of ongoing water and electrolyte losses). Rehydration is considered a resuscitation measure. In the emergency room, during the first 5 minutes, it is necessary to measure the patient's pulse rate, blood pressure, body weight, take blood to determine the hematocrit or relative density of blood plasma, electrolyte content, acid-base balance, coagulogram, and then begin jet injection of saline solutions.

The volume of solutions administered to adults is calculated using the following formulas.

Cohen's formula:

Y = 4(or 5)xPx(Ht _b -Ht _n ),

Where V is the determined fluid deficit (ml); P is the patient's body weight (kg); Ht _б is the patient's hematocrit: Htн _is the normal hematocrit; 4 is the coefficient for a hematocrit difference of up to 15, and 5 for a difference of more than 15.

Phillips formula:

V = 4(8) x 1000 x P x (X - 1.024),

Where V is the determined fluid deficit (ml); P is the patient's body weight (kg); X is the relative density of the patient's plasma; 4 is the coefficient for the patient's plasma density up to 1.040, and 8 is for the density above 1.041.

In practice, the degree of dehydration and, accordingly, the percentage of body weight loss are usually determined by the criteria presented above. The resulting figure is multiplied by the body weight to obtain the volume of fluid loss. For example, body weight is 70 kg, dehydration is grade III (8%). Therefore, the volume of loss is 70,000 g - 0.08 = 5600 g (ml).

Polyionic solutions, preheated to 38-40 °C, are administered intravenously at a rate of 80-120 ml/min at grades II-IV dehydration. Treatment of cholera is based on the use of various polyionic solutions. The most physiological are trisol (5 g sodium chloride, 4 g sodium bicarbonate and 1 g potassium chloride); acesol (5 g sodium chloride, 2 g sodium acetate, 1 g potassium chloride per 1 liter of apyrogenic water); Chlosol (4.75 g sodium chloride, 3.6 g sodium acetate and 1.5 g potassium chloride per 1 liter of pyrogen-free water) and lactasol solution (6.1 g sodium chloride, 3.4 g sodium lactate, 0.3 g sodium hydrogen carbonate, 0.3 g potassium chloride, 0.16 g calcium chloride 5 and 0.1 g magnesium chloride per 1 liter of pyrogen-free water).

Jet primary rehydration is performed by catheterization of central or peripheral veins. After losses have been replenished, arterial pressure has increased to the physiological norm, diuresis has been restored, and convulsions have ceased, the infusion rate is reduced to the required level to compensate for ongoing losses. The administration of solutions is crucial in the therapy of seriously ill patients. As a rule, pulse and arterial pressure begin to be determined 15-25 minutes after the start of administration, and dyspnea disappears in 30-45 minutes, cyanosis decreases, lips become warmer, and a voice appears. In 4-6 hours, the patient's condition improves significantly and he begins to drink independently. Every 2 hours, it is necessary to monitor the patient's blood hematocrit (or relative density of blood plasma), as well as the blood electrolyte content to correct infusion therapy.

It is a mistake to administer large amounts of 5% glucose solution: not only does this not eliminate the electrolyte deficiency, but, on the contrary, reduces their concentration in the plasma. Blood transfusion and blood substitutes are also not indicated. It is unacceptable to use colloidal solutions for rehydration therapy, as they contribute to the development of intracellular dehydration, acute renal failure and shock lung syndrome.

Oral rehydration is necessary for cholera patients who do not vomit. The WHO expert committee recommends the following composition: 3.5 g sodium chloride, 2.5 g sodium bicarbonate, 1.5 g potassium chloride. 20 g glucose, 1 liter of boiled water (oralit solution). Adding glucose promotes the absorption of sodium and water in the intestine. WHO experts have also proposed another rehydration solution in which the bicarbonate is replaced by a more stable sodium citrate (regidron). In Russia, a drug called glucosolan has been developed that is identical to the WHO glucose-salt solution.

Water-salt therapy is stopped after the appearance of fecal stools in the absence of vomiting and a predominance of urine over the amount of stool in the last 6-12 hours.

Etiotropic treatment of cholera

Antibacterial treatment of cholera is an additional means of therapy; they do not affect the survival of patients, but reduce the duration of clinical manifestations of cholera and accelerate the cleansing of the body from the pathogen.

Schemes of a five-day course of antibacterial drugs for the treatment of patients with cholera (HI degree of dehydration, no vomiting) in tablet form

Preparation	Single dose, g	Frequency of use, per day	Average daily dose, g	Course dose, g
Doxycycline	02	1	0.2	1
Chloramphenicol (chloramphenicol)	0.5	4	2	10
Lomefloxacin	0.4	1	0.4	2
Norfloxacin	0.4	2	0.8	4
Ofloxacin	0.2	2	0.4	2
Pefloxacin	0.4	2	0.3	4
Tetracycline	0.3	4	1,2
Trimethoprim + Sulfamethoxazole	0.16 0.8	2	0.32 1.6	1.6 8
Ciprofloxacin	0.25	2	0.5	2.5
Rifampicin + Trimethoprim	0.3 0.8	2	0.6 0.16	3 0.8

Schemes of a 5-day course of antibacterial drugs for the treatment of patients with cholera (presence of vomiting, III-IV degree of dehydration), intravenous administration

Preparation	Single dose, g	Frequency of use, per day	Average daily dose, g	Course dose, g
Amikacin	05	2	1.0	5
Gentamicin	0 08	2	0.16	0.8
Doxycycline	0.2	1	0.2	1
Kanamycin	05	2	1	5
Chloramphenicol (chloramphenicol)	1	2	2	10
Ofloxacin	0.4	1	0.4	2
Sizomycin	01	2	0.2	1
Tobramycin	0,1	2	0.2	1
Trimethoprim + sulfamethoxazole	0.16 0.8	2	0.32 1.6	1.6 8
Ciprofloxacin	0.2	2	0.4	2

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Clinical examination

Discharge of cholera patients (vibrio carriers) is carried out after their recovery, when rehydration and etiotropic treatment of cholera is completed and three negative results of bacteriological examination are received.

Those who have had cholera or are vibrio carriers are allowed to work (study) after being discharged from hospitals, regardless of their profession, and are registered with the territorial departments of epidemiological surveillance and the KIZ of the polyclinics at their place of residence. Dispensary observation is carried out for 3 months. Those who have had cholera are subject to bacteriological examination for cholera: in the first month, bacteriological examination of feces is carried out once every 10 days, then - once a month.

If vibrio carriage is detected in convalescents, they are hospitalized in an infectious diseases hospital to receive appropriate treatment for cholera, after which their outpatient observation is resumed.

Those who have had cholera or are carriers of vibrios are removed from the dispensary register if cholera vibrios are not isolated during the dispensary observation.

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