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8. Cholera. Treatment. Prevention
Treatment. The main condition for successful treatment is the rapid replacement of the excreted water and electrolytes.
Patients admitted in a state of severe dehydration and hypovolemic shock should immediately begin intravenous fluid administration. The choice of fluid for intravenous administration to the patient is determined by the nature of the losses. Moderately or slightly severe dehydration allows you to start treatment with enteral fluid. Solutions can be prepared using potable water, but should be prepared daily to avoid bacterial contamination. If necessary, the solution is administered through a gastric tube or nasogastric tube. Vomiting is not a contraindication to oral fluid administration, but fluid should be given in smaller amounts and more frequently. Glucose malabsorption and increased diarrhea occur in 1% of patients. In such cases, it is necessary to switch to an intravenous method of treatment.
After replacing the excreted fluid, it is necessary to continue maintenance therapy, compensating for the consumption of fluid and electrolytes with sweat and feces. Supportive hydration therapy can be carried out by enteral administration of electrolyte and glucose solutions.
Normal and nutritious nutrition, appropriate for age, should be started as soon as the child can eat, in order to prevent further deterioration of the condition of patients associated with malnutrition. High-calorie foods enriched with potassium should be prescribed.
2-6 hours after the start of intensive therapy and the removal of the patient from the state of shock, he is prescribed tetracycline for oral administration, which helps to reduce the duration of diarrhea and the volume of bowel movements by 50-70%, as well as reduce the period of bacteria isolation. Tetracycline and other etiotropic drugs are prescribed according to age dosages for a 5-day course.
Prevention. Cholera prevention is based on a system of measures aimed at preventing the introduction of infection from endemic foci; identification of patients and vibrio carriers, their timely isolation and rehabilitation of the pathogen; localization and elimination of the focus of infection with a system of quarantine measures, including isolation and examination of persons in contact with the sick person, provisional hospitalization of all those suffering from diarrheal diseases in the focus of infection.
Chemoprophylaxis for cholera consists in prescribing tetracycline 500 mg every 6 hours for children over 13 years old, 125 mg for children aged 4–13 years for 2 days, and 50 mg for children under 3 years of age. Simpler methods include a single dose of doxycycline (300 mg for adults and 6 mg/kg for children). Chemoprophylaxis is effective against family contacts. The effectiveness of mass chemoprophylaxis remains questionable.
Author: Pavlova N.V.
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