How Cholera Is Treated

Cholera can quickly drain the body of fluids, so timely treatment is essential. The primary method used to treat the disease is rehydration therapy, though antibiotics might also be prescribed in some cases.

Rehydration Therapy 

Because the greatest concern for cholera is the risk of dehydration, rehydration therapy is typically the first line of defense for people with symptoms.

These therapies can often be done at home, though in severe cases, rehydration might need to take place with the assistance of a medical team.

Oral Rehydration Therapies 

The vast majority of individuals with cholera can treat symptoms of dehydration on their own—often with ingredients they already have on-hand.

Rehydration drinks and dissolvable powders are frequently available in pharmacies, but in a pinch, a simple oral rehydration solution (ORS) can be made at home using the following formula

  • 1/2 a small spoonful of salt
  • 6 level spoonfuls of sugar 
  • 1 liter of water

How much of the ORS should be taken will depend on a person's size and age. Babies under 4 months old, for example, should get between 200 to 400 milliliters in the first four hours, whereas adults will need 2200 to 4000 milliliters in that timeframe. It's important to note, however, that if making the ORS at home (including using dissolvable powders), it's critical that clean, potable drinking water be used to avoid further contamination.

In the total absence of ORS, plain water can also help until an ORS can be taken, and breastfeed babies should continue to nurse if they're able.

Intravenous (IV) Rehydration Therapies 

In cases of severe dehydration, it might not be enough to try and rehydrate at home. Medical assistance using IV fluids might be needed to stave off shock or death—especially in small children.

These IV fluids are similar to the ORS in that they replenish liquids in the body, as well as badly needed electrolytes, but because they are inserted directly into the bloodstream they can more quickly counteract the effects of dehydration on the body.

In some cases, a person will be given ORS at the same time as an IV drip, then be switched over to just taking the ORS once hydration levels are more manageable.

Timing

Amounts and timings of both ORS and IV therapies might need to be adjusted depending on how severe the dehydration is and whether diarrhea and vomiting are still continuing. In all cases, the amount of fluids going in should be more than the estimated amount leaving the body.

Shortly after receiving these therapies, many will start to see the signs of rehydration, such as: 

  • Thirst has gone away 
  • Needing to urinate again at a normal rate, and the urine is light and transparent
  • Heart rate is back to normal 
  • When skin is pinched, it immediately goes back to its normal place

Both types of rehydration therapies have the potential to dramatically reduce one's risk of dying because of severe dehydration caused by cholera. When used quickly and appropriately, they can reduce fatalities to less than 1 percent of cases.

Antibiotics 

Most people with cholera (an estimated 80 percent) can recover using rehydration therapy alone. In severely ill cases, however, antibiotics can be used to shorten the length of time someone is sick, as well as how long they shed the bacteria in their stools.

These medications are used in addition to rehydration solutions—not in place of them. Antibiotics alone aren't enough to keep someone from dying from cholera, though they can reduce the amount of rehydration fluids a person will need.

Currently, doxycycline is the first-line drug of choice to treat cholera, but others—such as tetracycline, azithromycin, erythromycin, and others—have also been shown to be among the most effective treatments and may be recommended for special populations.

One reason these medications aren't more widely used is because of a growing threat of drug-resistant cholera strains that are increasingly impervious to tetracycline, among other anti-microbial treatments. It's suspected that the over-use of these kinds of medications has lead to the bacteria adapting to them, rendering the treatments less effective. As a result, doctors are encouraged to only prescribe antibiotics for moderate to severe cases who have already started to receive IV fluids.

Another reason these drugs aren't routinely used is that a side effect to some of these antimicrobials is nausea and vomiting, exacerbating unpleasant and sometimes dangerous symptoms already common in cholera cases.

Zinc 

Research has shown that zInc supplements given to kids with cholera can shorten the amount of time a child has diarrhea and make it less severe. When given alongside antibiotics and rehydration therapies, giving 10 to 20mg of zinc per day appeared to stop diarrhea 8 hours earlier and with 10 percent less volume than in cases where the supplement wasn't given.

This research is consistent with studies showing a similar effect for other diarrheal diseases, not just cholera.

Sources: 

Centers for Disease Control and Prevention. Cholera - Vibrio cholerae infection: Antibiotic treatment.

Centers for Disease Control and Prevention. Cholera - Vibrio cholerae infection: Rehydration therapy.