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AFRO-NETS> Cholera treatment and the role of antibiotics

Cholera treatment and the role of antibiotics
perceived by the doctors in the fields of Bangladesh

A. Cholera causes dehydration in human body. The first duty is to re-
plenish or correct the on going loss of the fluid resulting in dehy-
dration. If Cholera is diagnosed as the cause of diarrhea, an appro-
priate antibiotic cover has been revealed as beneficial regardless 
the degree of dehydration. The benefits of the immediate antibiotic 
coverage to a Cholera patient revealed in the field studies are as 
i) It considerably shortens the duration of the episodes of illness 
ii) It can prevent secondary infections/complications in an already 
less-nourished body of a Cholera patient with low immunity (caused by 
the disease).

B. Antibiotics: 
1.Age 0-6 months children: Erythromycin liquid orally in the dose of 
30 mg/kg/day 6 hourly for 5 days.

2. Age 6 months+ children: Erythromycin liquid (dose of 30 mg/kg/day 
6 hourly for 5 days) or Trimethoprim (TMP)-Sulphamethaxazole (SMX) 
(TMP 4mg/kg/day BD 3-5 days).

3. For older children and adults: Tetracycline 12.5mg/kg/day, 6 
hourly for 5 days or Furazolidone 1.25 mg/kg/day, 6 hourly for 5 

Note: In remote areas for re-hydration (correction of the dehydra-
tion/correcting the ongoing loss in diarrhea) of children and adults 
dehydrated in Cholera, ORS solution/Home made solution/rice-
water/fresh fruit juice/lentil water should be tried first in oral 
route. If the diarrhea and the resulting condition seems to be se-
vere, then it is lifesaving to start IV infusion of Cholera saline 
immediately. In remote areas, sometimes there is a lack of enough 
skilled personnel who can give IV infusion or can maintain it con-
tinuously for each patient. Also there is a lack of IV fluids, can-
nula or micro-burettes for the young children's IV infusion. 

In Bangladesh we got tremendous result introducing usage of NG tubes 
for naso-gastric ORS solution/home-made fluid ingestion. Dehydration 
can be conveniently corrected by this procedure. Skilled personnel 
from a mobile medical team covering a vast area can insert and fix 
the NG tube and the mothers or the caretakers can easily maintain it 
with considerable success. They can infuse ORT (ORS solution/home-
solution +food) through these naso-gastric channels without any big 
problem. The benefit of the NG tube infusion and feeding can contrib-
ute a lot in treating the Cholera patients in the remote areas, where 
there is a lack of skilled paramedics for injecting and maintaining 
IV infusions maintaining the 100% sterility. NG tube use can also 
avoid the untoward effects of 'IV fluid reactions', which sometimes 
threatens the life. 

After each loose stool, the mothers or the caretakers of the patients 
should give the following amount of ORS solution to the patients:
* 50-100 ml (1/4-1/2 cup) ORS solution to a child less than 2 years
* 100-200 ml (1/2-1 cup) for the child between 2-9 years old.

Please note that ORS solution orally can increase vomiting as it in-
creases nausea, so sometimes there are refusals, again establishing 
the superiority NG tube naso-gastric feeding and infusion. Composi-
tion of the Cholera fluid: In the year of 2000, I became surprised 
that a world reputed NGO (MSF-Holland) working on Cholera is still 
ordering the Ringer Lactate from their HQ. I requested them to use 
Cholera Saline, which is used in Bangladesh for more than last 10 

Composition of the Cholera Saline is as follows: 
a) Na+ 3.0 gm/l = 133 mmol/l 
b) K+  0.5 gm/l =  13 mmol/l 
c) Cl- 3.5 gm/l =  98 mmol/l 
d) Acetate 2.8 gm/l = 48 mmol/l 
e) Acetate is converted in to bicarbonate, which is required for cor-
rection of acidosis. In some solution, lactate is used instead of 
* Ringer's Lactate Solution contains low Potassium 4 mg/l 
* Normal saline can only be used where Cholera Saline or Ringer's 
  Lactate is not available. It contains no K+, no lactate or acetate 
  except 154 mmol/l Na+

Dr. S. M. Shamim ul Moula 
c/o Major (Dr.) Shormin Ara Ferdousi 
Child Specialist
Bangladesh Armed Forces 
140/8, Army Officers' Quarter
Shaheed Bashar (Staff) Road
Dhaka Cantonment
Dhaka-1206, Bangladesh 
Tel: +880-987-0011 ext. 3593(Res.), +880-18-231683 (24 hrs.)
Fax: +880-956-7048

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