Editing Cholera (section)

== Treatment ==
[[File:Cholera rehydration nurses.jpg|thumb|upright=1.3|Cholera patient being treated by [[oral rehydration therapy]] in 1992]]
Continued eating speeds the recovery of normal intestinal function. The WHO recommends this generally for cases of diarrhea no matter what the underlying cause.<ref name=WHOTreatmentOfDiarrhoea2005 /> A CDC training manual specifically for cholera states: "Continue to breastfeed your baby if the baby has watery diarrhea, even when traveling to get treatment. Adults and older children should continue to eat frequently."<ref name=CDCCommunityHealthWorkerTrainingManual>{{cite web|url=https://www.cdc.gov/cholera/pdf/chw-trainingmaterials-haiti-specific-508c.pdf|title=Community Health Worker Training Materials for Cholera Prevention and Control|publisher=[[Centers for Disease Control and Prevention]]|url-status=live|archive-url=https://web.archive.org/web/20170702064520/https://www.cdc.gov/cholera/pdf/chw-trainingmaterials-haiti-specific-508c.pdf|archive-date=2017-07-02}}</ref>

=== Fluids ===
The most common error in caring for patients with cholera is to underestimate the speed
and volume of fluids required.<ref>{{Cite web|url=http://globalhealthcenter.umn.edu/documents/Cholera-Lancet-July2012.pdf|archiveurl=https://web.archive.org/web/20131203010620/http://globalhealthcenter.umn.edu/documents/Cholera-Lancet-July2012.pdf|url-status=dead|title=globalhealthcenter.umn.edu|archivedate=December 3, 2013}}</ref> In most cases, cholera can be successfully treated with [[oral rehydration therapy]] (ORT), which is highly effective, safe, and simple to administer.<ref name=NEJM2006 /> Rice-based solutions are preferred to glucose-based ones due to greater efficiency.<ref name=NEJM2006 /> In severe cases with significant dehydration, [[intravenous]] rehydration may be necessary. [[Ringer's lactate]] is the preferred solution, often with added potassium.<ref name=Lancet2004 /><ref name=WHOTreatmentOfDiarrhoea2005>{{cite book |title=The treatment of diarrhoea: a manual for physicians and other senior health workers |date=2005 |publisher=World Health Organization |pages=10, 16–17 |isbn=978-92-4-159318-2 |hdl=10665/43209 |hdl-access=free }}</ref> Large volumes and continued replacement until diarrhea has subsided may be needed.<ref name=Lancet2004 /> Ten percent of a person's body weight in fluid may need to be given in the first two to four hours.<ref name=Lancet2004 /> This method was first tried on a mass scale during the [[Bangladesh Liberation War]], and was found to have much success.<ref>[https://foreignpolicy.com/articles/2011/03/21/the_civil_war_that_killed_cholera The Civil War That Killed Cholera] {{webarchive|url=https://web.archive.org/web/20131220165056/http://www.foreignpolicy.com/articles/2011/03/21/the_civil_war_that_killed_cholera |date=2013-12-20 }}, foreignpolicy.com.</ref> Despite widespread beliefs, fruit juices and commercial fizzy drinks like cola are not ideal for rehydration of people with serious infections of the intestines, and their excessive sugar content may even harm water uptake.<ref>{{cite news |title=Sugary drinks 'worsen vomit bug' |url=http://news.bbc.co.uk/2/hi/health/8010346.stm |work=BBC News |date=22 April 2009 }}</ref>

If commercially produced oral rehydration solutions are too expensive or difficult to obtain, solutions can be made. One such recipe calls for 1 liter of boiled water, 1/2 teaspoon of salt, 6 teaspoons of sugar, and added mashed banana for potassium and to improve taste.<ref>{{cite web|url=http://rehydrate.org/solutions/homemade.htm|title=Oral Rehydration Solutions: Made at Home|year=2010|access-date=2010-10-29|publisher=The Mother and Child Health and Education Trust|url-status=dead|archive-url=https://web.archive.org/web/20101124130823/http://rehydrate.org/solutions/homemade.htm|archive-date=2010-11-24}}</ref>

=== Electrolytes ===
As there frequently is initially [[acidosis]], the [[potassium]] level may be normal, even though large losses have occurred.<ref name=Lancet2004 /> As the dehydration is corrected, potassium levels may decrease rapidly, and thus need to be replaced.<ref name=Lancet2004 /> This is best done by Oral Rehydration Solution (ORS).<ref name=choleraoutbreaksteps />

=== Antibiotics ===
[[Antibiotic]] treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms.<ref name=Lancet2004 /> Use of antibiotics also reduces fluid requirements.<ref>{{cite report|date=November 28, 2011|title=Cholera Treatment|url=https://www.cdc.gov/cholera/treatment/index.html|publisher=Centers for Disease Control and Prevention (CDC)|url-status=live|archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html|archive-date=March 11, 2015}}</ref> People will recover without them, however, if sufficient hydration is maintained.<ref name=NEJM2006 /> The WHO only recommends antibiotics in those with severe dehydration.<ref name=choleraoutbreaksteps>{{cite web|title=First steps for managing an outbreak of acute diarrhea|url=https://www.who.int/topics/cholera/publications/en/first_steps.pdf|publisher=World Health Organization Global Task Force on Cholera Control|access-date=November 23, 2013|url-status=live|archive-url=https://web.archive.org/web/20140805150434/http://www.who.int/topics/cholera/publications/en/first_steps.pdf|archive-date=August 5, 2014}}</ref>

[[Doxycycline]] is typically used first line, although some [[Strain (biology)|strains]] of ''V.&nbsp;cholerae'' have shown [[Antibiotic resistance|resistance]].<ref name=Lancet2004 /> Testing for resistance during an outbreak can help determine appropriate future choices.<ref name=Lancet2004 /> Other antibiotics proven to be effective include [[cotrimoxazole]], [[erythromycin]], [[tetracycline]], [[chloramphenicol]], and [[furazolidone]].<ref>{{cite web |archive-url=https://web.archive.org/web/20121106021041/http://sprojects.mmi.mcgill.ca/tropmed/disease/chol/treatment.htm|archive-date=6 November 2012|url=http://sprojects.mmi.mcgill.ca/tropmed/disease/chol/treatment.htm |title=Cholera treatment|publisher=Molson Medical Informatics |year=2007 |access-date=2008-01-03}}</ref> [[Fluoroquinolone]]s, such as [[ciprofloxacin]], also may be used, but resistance has been reported.<ref>{{cite journal | vauthors = Krishna BV, Patil AB, Chandrasekhar MR | title = Fluoroquinolone-resistant Vibrio cholerae isolated during a cholera outbreak in India | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 100 | issue = 3 | pages = 224–6 | date = March 2006 | pmid = 16246383 | doi = 10.1016/j.trstmh.2005.07.007 }}</ref>

Antibiotics improve outcomes in those who are both severely and not severely dehydrated.<ref name="Lei2014">{{cite journal | vauthors = Leibovici-Weissman Y, Neuberger A, Bitterman R, Sinclair D, Salam MA, Paul M | title = Antimicrobial drugs for treating cholera | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD008625 | date = June 2014 | volume = 2014 | pmid = 24944120 | pmc = 4468928 | doi = 10.1002/14651858.CD008625.pub2 }}</ref> [[Azithromycin]] and [[tetracycline]] may work better than [[doxycycline]] or [[ciprofloxacin]].<ref name="Lei2014" />

=== Zinc supplementation ===
In Bangladesh [[zinc]] supplementation reduced the duration and severity of diarrhea in children with cholera when given with antibiotics and rehydration therapy as needed. It reduced the length of disease by eight hours and the amount of diarrhea stool by 10%.<ref name=CDC2013>{{cite report|date=November 28, 2011|title=Cholera-Zinc Treatment|url=https://www.cdc.gov/cholera/treatment/zinc-treatment.html|publisher=Centers for Disease Control and Prevention (CDC)|url-status=live|archive-url=https://web.archive.org/web/20131203084037/http://www.cdc.gov/cholera/treatment/zinc-treatment.html|archive-date=December 3, 2013}}</ref> Supplementation appears to be also effective in both treating and preventing infectious diarrhea due to other causes among children in the developing world.<ref name=CDC2013 /><ref>{{cite journal | vauthors = Telmesani AM | title = Oral rehydration salts, zinc supplement and rota virus vaccine in the management of childhood acute diarrhea | journal = Journal of Family & Community Medicine | volume = 17 | issue = 2 | pages = 79–82 | date = May 2010 | pmid = 21359029 | pmc = 3045093 | doi = 10.4103/1319-1683.71988 | doi-access = free }}</ref>