Treatment and Monitoring

The cornerstone of cholera treatment is fluid replacement. Without treatment, the case-fatality rate for severe cholera is approximately 50%. For cholera, rice-based ORT is better than glucose-based ORT because it reduces the number of stools.18 Patients with significant disease should receive a short antibiotic course to shorten the duration of illness and decrease the number of stools. Azithromycin 1 g (20 mg/kg for children) orally given once is the regimen of choice. Ciprofloxacin 1 g (20 mg/kg for children) orally given once is an alternative but is associated with higher failure rates. Ciprofloxacin is associated with joint damage in children and should not be given to children under 18 years of age unless they cannot be treated with other antibiot-

ics. Antibiotic resistance has been documented in V. cholerae since 1977. Antibiotic prophylaxis is not warranted.

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