Cholera is a diarrhoeal disease found in some developing countries in Asia, Africa, and South America. Although it is easily treatable, many people still succumb to the severe dehydration caused by diarrhoea. The medications used in the prevention and treatment of cholera can only be accessed by prescription, so it is important if one suspects cholera to visit a doctor immediately.
In June 2016, a vaccine that prevents cholera infection was developed, known as Vaxchora. It is administered by mouth as a single dose to travellers going to cholera-affected areas, although it is not given to people living in these areas. The dose should be taken at least ten days before departing to the cholera-affected area. The safety of Vaxchora in children and the elderly has not been confirmed, and it only provides protection against one common subtype of cholera known as serotype O1. However, it is the only vaccine for cholera approved by the FDA.
Antibiotic treatment of cholera
The primary goal of cholera treatment is the fluid replacement. Drug treatment is secondary, and will only be given in very severe cases where fluid loss may be life threatening. The top anti-cholera drugs used to hasten clearance of the infection, are antibiotics.
First line treatment
The drug of choice to treat cholera is a powerful antibiotic called doxycycline (commercially known as Monodox, Oracea, and Vibramycin). It is administered as a single dose of 300mg, which decreases the severity of symptoms, and may reduce the amount of time spent ill. Doxycycline is not used in pregnant women or children. For these special groups, other antibiotics need to be used.
If doxycycline is contraindicated, azithromycin (commercially known as Zithromax or Zmax) may be given. Although azithromycin has recently been proven to be more effective as a second choice drug, many world organizations still recommend the use of tetracycline, erythromycin or ciprofloxacin instead.
Resistance against tetracycline has emerged in some areas, and recently, ciprofloxacin resistance has also occurred in parts of India. This means that these drugs are more likely to fail, and are therefore losing popularity as alternatives for the treatment of cholera.
Fluid replacement therapy
Essentially, fluid replacement therapy is the mainstay of cholera treatment, as drugs have a limited effect. Mild to moderate dehydration can be treated using a home-made solution of six to eight teaspoons of sugar and half a teaspoon of salt dissolved in a litre of boiled water. This should be drinking multiple times per day. If severe dehydration sets in, a drip of Ringer’s lactate, a popular fluid replacement, will be set up in the hospital, to assist with rehydration.
If you are travelling to a cholera-affected area, it is important to know the signs and symptoms of cholera, so that you can get treatment immediately. If you do get infected, make sure your doctor prescribes the correct medications for speedy treatment and recovery.