Cholera is an acute intestinal infectious disease caused by Vibrio cholerae, with treatment goals focused on rapidly replenishing body fluids and electrolytes to prevent dehydration and organ failure. The key to treatment is the immediate implementation of rehydration therapy, selecting appropriate treatment methods based on the severity of the condition. In areas with scarce medical resources, simple oral rehydration salts (ORS) can effectively reduce mortality, while severe cases require immediate intravenous rehydration.
The strategy for treating cholera must combine supportive therapy with specific drug treatment. Rehydration is the foundational therapy that can restore the body's fluid and electrolyte balance. In terms of drug treatment, antibiotics can shorten the duration of illness and the period of bacterial shedding, but not all cases require their use. Close monitoring of the patient's vital signs is necessary during treatment, and the regimen should be adjusted based on symptoms. Preventing complications such as hypotension or renal dysfunction is also an important component of treatment.
Current cholera treatment is primarily divided into three stages: initial rehydration, oral treatment for moderate dehydration, and intravenous treatment for severe dehydration. First-line treatment always focuses on rehydration, with the WHO recommending oral rehydration salts (ORS) as the first choice for mild to moderate dehydration. ORS should be diluted as instructed and consumed in small sips to avoid overwhelming the intestines.
For patients with severe dehydration or altered consciousness, intravenous fluid therapy must be initiated immediately. Commonly used intravenous fluids include normal saline and lactated Ringer's solution, with strict control over the infusion rate and total volume. In medical facilities, central venous catheters may be used to monitor blood pressure and blood oxygen saturation. Rehydration therapy should continue until the patient can resume normal eating.
Antibiotics can shorten the duration of bacterial shedding and the persistence of symptoms, but not all patients need to use them. Commonly used antibiotics include doxycycline and tetracyclines, but sensitivity of the pathogen must be confirmed before use. Caution should be exercised in selecting the type and dosage of medication for children, pregnant women, and those with liver or kidney dysfunction.
Recent guidelines suggest that for suspected cholera cases, prophylactic use of antibiotics may be warranted if symptoms are severe or there is an epidemiological history of exposure. However, care must be taken as antibiotic misuse can lead to resistance issues, and the decision to use them should be made by a physician. During treatment, close observation for drug side effects, such as gastrointestinal discomfort or allergic reactions, is necessary.
Antibiotics should be used under the following conditions: moderate to severe symptom severity, a clear epidemiological history of exposure, or the patient has high-risk factors such as immunodeficiency. Common medication choices include:
Non-drug therapy is fundamental to treatment, including the immediate replenishment of lost fluids and electrolytes. Patients should continuously consume clean water, rice soup, or oral rehydration salts, avoiding high-sugar beverages. In medical facilities, nasogastric tubes may be used to assist with rehydration, or electrolyte colloidal solutions may be used to maintain hemodynamic stability.
Isolation treatment is an important measure to control the spread of the epidemic. Patient excreta must be strictly disinfected, and medical personnel should wear protective gear. Improving environmental hygiene, such as disinfecting drinking water and cooking food thoroughly, is key non-drug measures to prevent reinfection.
In areas with limited medical resources, initial management can be performed in the following ways:
During the recovery phase, the diet should gradually return to normal, initially focusing on liquid or semi-liquid foods, such as rice porridge and clear broth. Gradually increase easily digestible carbohydrate sources, such as bananas and dry bread. During treatment, avoid dairy products and high-fiber foods to prevent intestinal irritation.
Water hygiene is key to preventing recurrence. Water should be boiled or treated with a filtration system before drinking. Food must be thoroughly heated to a center temperature exceeding 70°C, avoiding raw seafood or unwashed fresh fruits and vegetables. Patients may still carry the bacteria for two weeks after recovery, so personal hygiene should be emphasized to prevent transmission.
Dietary recommendations during the recovery phase should be phased:
Recent research has focused on developing more effective oral rehydration formulas, such as adding glutamine or probiotics to promote intestinal repair. Genetic engineering technology may be applied to develop new vaccines targeting cholera toxin factors, with oral live vaccines already being promoted in epidemic areas.
Nano-technology is being researched for developing gut-targeted drugs that directly act on pathogens to reduce systemic side effects. Artificial intelligence-assisted diagnostic systems can accelerate case grading, helping healthcare providers adjust treatment plans in real-time, especially during outbreaks to enhance treatment efficiency.
Developing treatment technologies face the following challenges:
Seek medical attention immediately if the following symptoms occur: profuse watery diarrhea accompanied by fever, persistent vomiting preventing rehydration, or severe dehydration symptoms such as skin peeling or lack of tears. If there has been contact with a cholera patient and similar symptoms develop, professional diagnosis should be sought within 24 hours.
Special populations such as pregnant women, seniors over 65, and immunocompromised individuals should seek medical attention promptly even for mild symptoms. If diarrhea or fatigue recurs within two weeks after treatment, a follow-up visit is necessary for bacterial culture to confirm whether there is a recurrence or secondary infection.
The following conditions should be considered medical emergencies:
Oral rehydration is primarily 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 rehydration to rapidly replenish electrolytes and fluids. Physicians will determine the treatment method based on the degree of dehydration, consciousness state, and intestinal absorption capacity.
Are antibiotics necessary in cholera treatment? What side effects should be noted when using them?Antibiotics can shorten the duration of illness and the period of bacterial shedding, but not all patients need to use them. Common medications such as doxycycline or fluoroquinolones may cause increased diarrhea or gastrointestinal discomfort. Physicians will decide whether to prescribe based on the severity of the infection, the patient's age, and antibiotic resistance data.
After receiving the oral cholera vaccine, is it still necessary to pay attention to water hygiene?Vaccination can reduce the risk of infection but cannot completely prevent it. It is still necessary to drink boiled or bottled water and avoid raw seafood, as the vaccine may have limited efficacy against certain strains. After vaccination, it is recommended to maintain good hygiene practices, especially when traveling to endemic areas.
How should patients adjust their diet in the early recovery phase? When can they resume a normal diet?In the early recovery phase, a low-fiber, easily absorbable diet is recommended, such as rice porridge, crackers, and cooked vegetables, avoiding dairy products and high-fiber fruits and vegetables. Once the frequency of diarrhea significantly decreases and there is no abdominal pain, normal eating can gradually resume in about 3-5 days, but high-fat or irritating foods should be avoided.
What symptoms during home care indicate the need for immediate medical attention?If persistent vomiting prevents fluid intake, urine output decreases for more than 8 hours, skin becomes dry and loses elasticity, or consciousness is altered, it indicates possible severe dehydration and must be sent to the hospital immediately. Even if symptoms improve slightly, if there is no improvement within 24 hours, medical attention is still necessary and should not rely solely on home care.
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