There is currently an epidemic of cholera in Haiti. Should all patients with cholera be treated with antibiotics? International guidelines recommend that patients with moderately severe and severe cholera be treated promptly with antibiotics. How do we differentiate between a mild case, a moderately severe case and a severe case of cholera? We can do that by looking at the degree of dehyration. A severe case of cholera is one where the dehyration amounts to 10 percent or more of the body weight. A moderately severe case is one where the dehydration amounts to 5 to 10 percent of the body weight. And a mild case will be one where the dehyration is minimal, less than 5 percent of body weight.
So, what are the antibiotics that can be used for cholera? Doxycycline, Azithromycin or Ciprofloxacin can be used.
Should contacts of cholera patients be given prophylactic antibiotics? The answer is No. Finally, when should a doctor suspect cholera? Cholera should be suspected in any diarrhoeal illness of short duration (less than 24 hours) which is associated with dehydration. Vomiting often accompanies the diarrhoea and there is no fever.
This site has the WHO guidelines for cholera treatment and a good write-up on the antibiotics of choice for the disease.
(NB: Only a single dose of an antibiotic is needed for treatment of cholera. Either 300mg OD Doxycycline or 1gram OD Azithromycin or 1gram OD Ciprofloxacin)
