Cholera: treatment

A special diet for patients with cholera is not required.

Treatment of cholera should pursue the following basic principles:

• compensation of fluid loss and restoration of electrolyte composition of the body;
• effects on the pathogen.

Treatment of cholera must begin in the first hours after the onset of the disease.

[1], [2],

Pathogenetic treatment of cholera

This treatment of cholera includes primary rehydration (compensation of losses of water and salts before treatment) and corrective compensatory rehydration (correction of continuing losses of water and electrolytes). Rehydration is seen as a resuscitation exercise. In the receiving rest for the first 5 minutes, the patient needs to measure the pulse rate, blood pressure, body weight, take blood to determine hematocrit or relative density of blood plasma, the content of electrolytes, acid-base state, coagulogram, and then start the jet infusion of saline solutions.

The volume of solutions administered by an adult is calculated by the following formulas.

Cohen's formula:

Y = 4 (ili5) hRh (Ht _b -Nt _N )

Where V - determined fluid deficiency (ml); P - body weight of the patient (kg); Ht _b - hematocrit of the patient: Ht _n - hematocrit normal; 4 - factor with a hematocrit difference of up to 15, and 5 - with a difference of more than 15.

Formula Phillips:

V = 4 (8) х 1000 х Р х (X - 1,024),

Where V - determined fluid deficiency (ml); P - body weight of the patient (kg); X is the relative density of the patient's plasma; 4 - coefficient at the plasma density of the patient to 1,040, and 8 - at a density above 1,041.

In practice, the degree of dehydration and, correspondingly, the percentage of body weight loss is usually determined by the criteria presented above. The resulting figure is multiplied by the body weight and the volume of fluid loss is obtained. For example, a body weight of 70 kg, dehydration of the third degree (8%). Consequently, the volume of losses is 70,000 g-0.08 = 5600 g (ml).

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

Initial primary rehydration is performed by catheterization of the central or peripheral veins. After replenishment of losses, increase of arterial pressure to physiological norm, recovery of diuresis, cessation of convulsions, the speed of infusion is reduced to the necessary to compensate for the continuing losses. The introduction of solutions is crucial in the treatment of seriously ill patients. As a rule, after 15-25 minutes after the beginning of the injection, the pulse and blood pressure begin to be determined, and after 30-45 minutes, dyspnea disappears, cyanosis decreases, the lips warm, a voice appears. After 4-6 hours the patient's condition improves significantly, he begins to drink on his own. Every 2 hours, it is necessary to monitor the hematocrit blood of the patient (or the relative density of the blood plasma), as well as the content of blood electrolytes for correction of infusion therapy.

The mistake is to inject large amounts of 5% glucose solution: this not only does not eliminate the deficiency of electrolytes, but, on the contrary, reduces their concentration in the plasma. Transfusion of blood and blood substitutes is not shown. Use colloidal solutions for rehydration therapy is unacceptable, as they contribute to the development of intracellular dehydration, acute renal failure and shock lung syndrome.

Oral rehydration is necessary for patients with cholera, who do not have vomiting. 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 of glucose, 1 l of boiled water (solution oralit). Adding glucose contributes to the absorption of sodium and water in the intestine. WHO experts also proposed another rehydration solution in which bicarbonate was replaced by more resistant sodium citrate (rehydron). In Russia, a preparation of glucosolan, which is identical to the glucose-saline solution of WHO, has been developed.

Water-salt therapy is discontinued after the appearance of stool feces in the absence of vomiting and the prevalence of urine over the amount of feces in the last 6-12 hours.

Etiotropic treatment of cholera

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

Schemes of a five-day course of antibacterial drugs for the treatment of patients with cholera (HI degree of dehydration, absence of vomiting) in tableted form

A drug	Single dose, g	Multiplicity of application, per day	Average daily dose, g	Course dose, g
Doxycycline	02	1	0.2	1
Chloramphenicol (Levomycetin)	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 5-day course of antibacterial drugs for the treatment of patients with cholera (presence of vomiting, III-IV degree of dehydration), intravenous administration

A drug	Single dose, g	Multiplicity of application, 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 (Levomycetin)	1	2	2	10
Ofloxacin	0.4	1	0.4	2
Sisomycin	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

[3], [4], [5], [6]

Clinical examination

The discharge of patients with cholera (vibrio-carriers) is made after their recovery, when the rehydration and etiotropic treatment of cholera is completed and three negative results of bacteriological examination are obtained.

Cholera transferred or vibrio-carrying after discharging from hospitals are allowed to work (study), irrespective of the profession, polyclinics at the place of residence are registered in the territorial departments of epidemiological surveillance and CIC. Dispensary follow-up is carried out within 3 months. The transferred cholera are subject to bacteriological examination on the cholera: in the first month a bacteriological study of the feces is performed once in 10 days, then - once a month.

When detecting vibrio-bearers in convalescents, they are hospitalized in an infectious hospital in order to conduct appropriate treatment for cholera, after which follow-up visits are resumed.

Cholera transferred or vibrio-carrying is removed from dispensary registration if cholera vibrios are not allocated during dispensary observation.

[7], [8], [9], [10], [11], [12],