Adjuncts to Therapy
Antibiotics should be given as soon as vomiting has stopped, which is usually after three to four hours of oral rehydration. Injectable antibiotics have no special advantages. No other medication should be given to treat cholera, like anti–diarrheas, anti–emetics, anti–spasmodic, cardio tonics and corticosteroids. Antibiotics used are tetrocycline, doxycycline Furazolidinen and Bactrim.

Sanitation Measures for Cholera
Water control: As water is the most important vehicle of transmission of cholera, all steps must be taken to provide properly treated, or otherwise safe water to the community for all purposes (drinking, washing and cooking.) In urban areas, properly treated drinking water containing residual chlorine should be made available to all families. This water should be stored in the household in narrow mouthed, covered containers. In rural areas, water can be made safe by boiling or by chlorination.

Chemoprophylaxis
Mass chemoprophylaxis is not advised for the total community in order to prevent one serious case of cholera.

Vaccination
The cholera vaccine is the only specific prophylactic available against cholera.

Dosage
Primary Immunization consists of two equal doses, injected subcutaneously, at an interval of about four to six weeks. The vaccine is not given to children under one year of age.

Reactions
Cholera inoculation is generally accompanied by local tenderness, mild swelling, even some redness, and occasionally, mild to moderate temperature elevation.

Protective Value
The protective value of currently available vaccines is estimated at about 50% for a period of about three to six months. To sum up, cholera vaccines available at present are not helpful in the control and prevention of the disease. They can be used as an adjunct to other preventive measures such as drug prophylaxis, sanitation and health education. The World Health Assembly in May 1973 abolished the requirement of a cholera vaccination certificate for international travel, although a few countries (e.g. Sudan, Libya) continue to demand such a certificate.

Health Education on Cholera
The most effective prophylactic measure is perhaps, health education. It should be directed mainly to:

1. The effectiveness and simplicity of oral rehydration therapy.
2. The benefits of early reporting for prompt treatment.
3. Food hygiene practices.
4. Hand washing after defecation and before eating.
5. The benefit of cooked, hot foods and safe water. Since cholera is mainly a disease of the poor and ignorant, these groups should be tackled first.

Prompt & Adequate
Replacement of water & electrolytes is very important. It may be given orally or Intravenously.

Clinical Management
Early treatment, in most cases by oral rehydration therapy, can reduce the case fatality of cholera to less than 1%. If treatment is delayed or inadequate, death from dehydration and circulatory collapse may follow rapidly.

A. Oral Rehydration Therapy
For mild cases Oral Rehydration Salt is recommended
Recommended ORS solution - WHO formula
Compostion of ORS
(net weight = 27.9gm)

ORS is available in powder form, in following composition which is recommended by WHO. The powder is to be dissolved in one litre of water & given orally as per schedule given in table:

Sr. No	Ingredient	Weight (gm)
1	Sodium Chloride IP	3.5
2	Potassium Chloride IP	1.5
3	Sodium citrate IP	2.9
4	Glucose anhydrous IP	20.0

ORS packets are available at all subcentres, PHCs and other hospitals. Depot holders are established at villages & Padas in Tribal area.

The age-wise requirement of ORS is as follows:
The ORS schedule is of 4 hours

Age	Dose
0-6 months	250 ml(1/4 litre)
6 months to 1 year	500 ml(1/2 litre)
1 year to 2 year	750 ml(3/4 litre)
2 years to 5 years	1 litre
5 years to 15 years	1 to 2 litres
Above 15 years	2 to 4 litres

• If the patient is thirsty and wants to drink more, allow to drink.
• After rehydration has been achieved, continue giving ORS solution for replacement of ongoing losses. Plain water and home available fluids can be taken.

Signs of dehydration are to be checked until they subsides.

Introduction of ORS has reduced cost of treatment & is very effective way to reduce morbidity & mortality due to dehydration.

Development of Oral rehydration therapy is a major breakthrough in the fight against cholera and other diarrhoeal diseases.

B. Intravenous Therapy - For sever cases of cholera I.V. infusion of fluid & electrolyte is required.

Age wise requirement of I.V. Infusion

Age Group	Quantity required	Frequency (Timing)
Infants	30 ml/kg body weight 70 ml/kg body weight	1st hour Next five hours
Older Children/Adults	30 ml/kg body weight 70 ml/kg body weight	1st 30 min next 2 & half hours