Cholera is an acute intestinal infectious disease caused by Vibrio cholerae. The primary goal of treatment is to rapidly replenish fluids and electrolytes to prevent dehydration and organ failure. The key to treatment is prompt rehydration therapy, with the choice of specific treatment depending on the severity of the condition. In areas with limited medical resources, simple oral rehydration salts (ORS) can effectively reduce mortality, while severe cases require immediate intravenous fluid administration.
The strategy for treating cholera combines supportive therapy with specific pharmacological treatments. Rehydration is the foundation, restoring the body's water and electrolyte balance. Regarding medication, antibiotics can shorten the duration of illness and bacterial shedding, but are not necessary for all cases. Close monitoring of vital signs and symptom-based adjustments are essential. Preventing complications such as hypotension or renal dysfunction is also a critical part of treatment.
Presently, cholera treatment is divided into three stages: initial rehydration, oral treatment for moderate dehydration, and intravenous therapy for severe dehydration. The first-line treatment always focuses on rehydration. The WHO recommends oral rehydration salts (ORS) as the first choice for mild to moderate dehydration. ORS should be diluted as instructed and sipped in small amounts to avoid overwhelming the intestines.
For patients with severe dehydration or altered consciousness, immediate intravenous infusion is necessary. Common fluids include normal saline and lactated Ringer's solution, with strict control over infusion rate and total volume. In medical facilities, central venous catheters may be used to monitor blood pressure and oxygen saturation. Rehydration should continue until the patient can eat normally.
Antibiotics can shorten the bacterial shedding period and symptom duration but are not required for all patients. Common antibiotics include doxycycline and tetracyclines, but susceptibility testing should be performed before use. Caution is advised for children, pregnant women, and those with liver or kidney dysfunction regarding drug selection and dosage.
The latest guidelines suggest prophylactic antibiotic use in suspected cholera cases with severe symptoms or epidemiological contact. However, overuse of antibiotics may lead to resistance issues, so treatment should be evaluated and decided by a physician. During therapy, monitor for side effects such as gastrointestinal discomfort or allergic reactions.
Antibiotics should be used when: symptoms are moderate or above in severity, there is confirmed epidemiological contact, or the patient has high-risk factors such as immunodeficiency. Common choices include:
Non-drug therapy is the cornerstone of treatment, including immediate rehydration with water and electrolytes. Patients should continuously intake clean water, rice water, or oral rehydration salts, avoiding high-sugar beverages. In medical facilities, nasogastric tube rehydration or electrolyte colloid solutions may be used to maintain hemodynamic stability.
Isolation is an important measure to control the spread of the epidemic. Excreta must be disinfected strictly, and healthcare workers should wear protective equipment. Improving environmental hygiene, such as disinfecting drinking water and thoroughly cooking food, is key to preventing reinfection and is considered a non-pharmacological measure.
In resource-limited settings, initial management can include:
During recovery, gradually resume eating, starting with liquids or semi-liquids such as rice porridge and clear broths. Gradually increase easily digestible carbohydrate sources like bananas and plain bread. Avoid dairy products and high-fiber foods during treatment to prevent intestinal irritation.
Maintaining water hygiene is crucial for prevention. Water should be boiled or filtered. Food must be thoroughly cooked to an internal temperature above 70°C, avoiding raw seafood or unwashed fresh vegetables and fruits. Patients may still carry bacteria within two weeks of recovery, so personal hygiene and prevention of transmission are important.
Diet during recovery should be phased:
Recent research focuses on developing more effective oral rehydration formulas, such as adding glutamine or probiotics to promote intestinal repair. Genetic engineering techniques may be used to develop new vaccines targeting cholera toxin factors; currently, oral live-attenuated vaccines are being promoted in endemic areas.
Nanotechnology is under investigation for developing intestinal-targeted drugs that act directly on the pathogen, reducing systemic side effects. AI-assisted diagnostic systems can accelerate case stratification and help healthcare providers adjust treatment plans in real-time, especially during outbreaks, improving treatment efficiency.
Developing new treatments faces the following challenges:
Seek medical attention immediately if symptoms include: large volume of watery diarrhea with fever, persistent vomiting preventing rehydration, skin with fish-scale appearance or absence of tears indicating severe dehydration. If exposed to a cholera patient and symptoms appear, seek professional diagnosis within 24 hours.
Special populations such as pregnant women, elderly over 65, and immunocompromised individuals should seek medical care promptly even with mild symptoms. If diarrhea or fatigue recurs within two weeks after treatment, return for bacterial culture to confirm relapse or ongoing infection.
Oral rehydration is mainly suitable for patients with mild to moderate dehydration who can drink independently and do not have severe vomiting. Severe dehydration or altered consciousness requires immediate intravenous infusion to rapidly replenish electrolytes and fluids. The physician will determine the treatment method based on the dehydration level, consciousness, and intestinal absorption capacity.
Is antibiotic necessary in cholera treatment? What side effects should be watched for?Antibiotics can shorten the disease course and bacterial shedding time but are not necessary for all patients. Common drugs include doxycycline and fluoroquinolones, which may cause diarrhea worsening or gastrointestinal discomfort. The doctor will decide whether to prescribe based on infection severity, patient age, and antibiotic resistance data.
After oral cholera vaccination, should water hygiene still be observed?The vaccine reduces infection risk but does not eliminate it entirely. Continue drinking boiled or bottled water, avoiding raw seafood, as vaccine efficacy may be limited against certain strains. Maintaining good hygiene practices is recommended even after vaccination, especially when traveling to endemic areas.
How should diet be adjusted during early recovery? When can normal eating resume?Early in recovery, a low-fiber, easily digestible diet such as plain rice porridge, plain biscuits, and cooked vegetables is recommended. Avoid dairy and high-fiber fruits until diarrhea significantly decreases and abdominal pain subsides, usually around 3-5 days. Gradually return to normal diet, avoiding high-fat or刺激性 foods.
What symptoms during home care indicate the need for immediate medical attention?If persistent vomiting prevents water intake, urine output decreases for more than 8 hours, skin elasticity decreases, or consciousness is clouded, these may indicate severe dehydration requiring urgent hospitalization. Even if symptoms improve temporarily, if no improvement within 24 hours, seek medical care. Do not rely solely on home management.
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