Treatment: Cholera

Rapid fluid replacement is critical, preferably with the WHO's reduced-osmolarity oral rehydration solution (ORS), which contains (per liter of water) Na⁺, 75 mmol; K⁺, 20 mmol; Cl^-, 65 mmol; citrate, 10 mmol; and glucose, 75 mmol.

• If available, rice-based ORS is considered superior to standard ORS for cholera.
• If ORS is not available, a substitute can be made by adding 0.5 teaspoon of table salt (NaCl; 3.5 g) and 6 teaspoons of table sugar (sucrose) to 1 L of safe water, with potassium provided separately (e.g., in orange juice or coconut water).
• Severely dehydrated pts should be managed initially with IV hydration (preferably with Ringer's lactate), with the total fluid deficit replaced in the first 3-4 h (half within the first hour).
• Antibiotic therapy (azithromycin, a single 1-g dose; erythromycin, 250 mg PO qid for 3 days; tetracycline, 500 mg PO qid for 3 days; or ciprofloxacin, 500 mg PO bid for 3 days) diminishes the duration and volume of stool.