Evidence-based management of Cholera according to Uganda Clinical Guidelines 2023
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
Sudden onset of massive, frequent watery stools (rice-water stools) without mucus/blood. Copious effortless vomiting, severe dehydration (thirst, loss of skin elasticity, sunken eyes, dry tongue/mucosa, feeble fast pulse, low BP). Afebril/subnormal temperature. Severe muscle cramps. Metabolic acidosis. Stool microscopy for motile vibrios.
Emergency Management
Rehydration (Primary)
Up to 90% require only prompt oral rehydration. Start ORS at HC1/2 and refer for isolation. Severe dehydration requires IV fluids (Ringer’s lactate). Give maintenance fluid; at least 4-5 litres/day. IV glucose for hypoglycemia.
Antimicrobial Therapy (Severe only)
Doxycycline 300 mg single dose (Children: 4 mg/kg single dose). OR Erythromycin 25-50 mg/kg every 6 hours for 3 days in children <12 years. OR Ciprofloxacin 1 g single dose or 20 mg/kg 12 hourly for 3 days. Note: Ciprofloxacin/Doxycycline usually contraindicated in pregnancy/children <8yrs but single dose in cholera should not provoke adverse effects. Alternative: Erythromycin 500 mg every 6 hours for 5 days.
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