Treatment and prevention of cholera

  • Etiology, epidemiology and pathogenesis of cholera
  • The clinical picture of cholera
  • Diagnosis of cholera
  • Treatment of cholera in the main pathogenetic aimed at restoration of violated in the patient's body water and electrolyte balance. Rehydration therapy is equal to the intensive care activities and are conducted in the volume corresponding loss of water and salts. Patients injected inkjet (in the following drip) saline№ 1 (5:4 :1), contains 5 grams of sodium chloride, 4 g of sodium bicarbonate (soda) and 1 g of chloride of potassium per 1 liter of distilled or, better, bidistilled apirogennuju water.
    The amount of added salt solution depending on the degree of dehydration and the patient ranges from 10 to 20 - 30 l and more in the course of treatment (3 - 4 days).
    If necessary (hyperkalemia) use a solution № 2 (6 : 4), contains 6 grams of sodium chloride and 4 g of sodium bicarbonate. These solutions imposed in case of severe and moderate flow of cholera. Mild form of the disease of water-salt solutions assign inside.
    Widely used in complex with pathogenetic means antibiotics -tetracycline, oletetrin, erythromycin, chloramphenicol. Tetracycline designate tablets 300 000 IU 4 times a day for 5 days; chloramphenicol - 0.5 g 4 times a day for 5 days.
    Patient cholera needs good care, warm, oxygen, excessive drinking, his appointed individual nursing post.

    Treatment
    Treatment for cholera carried out taking into account features of pathogenesis and clinical picture of the disease; it includes a set of causal, pathogenetic and symptomatic funds. G. P. Rudnev (1945) formulated main tasks of rational pathogenetic treatment, which are as follows: combat dehydration, desalting, hypoproteinemia, metabolic disorders and other consequences of toxicity, in particular with acidosis.
    Recently widely used antibiotic therapy with cholera. Has not lost its significance and sulfa drugs (sulgin, sulfadimezin, and others). Last appoint 1 g 5-7 times a day for 7-10 days. Treatment with antibiotics, sulfonamides do not exclude proven means of pathogenetic therapy, and the use of phage. Of antibiotics was effective tetracycline, streptomycin, signalizing, oletetrin, chloramphenicol. Tetracycline prescribed in tablets of 200 000 IU 4 times a day, and at impossibility of introduction of the drug by mouth (vomiting) to impose its intramuscularly in 1% solution novokaina 4 times per day for 200 000 IU. Pills oletetrina give to the patient 250 000 E D 4 times a day. In severe condition of the patient use sigmameter intramuscularly in a dose of 100 mg 3-4 times a day. While improving the condition of the patient (termination vomiting) treatment can be continued by oletetrina. The duration of antibiotic treatment depends on the disease, but not less than 7 days. Antibiotic treatment may be accompanied by adverse allergic reactions that require desensitizing funds (Dimedrol, promethazine, suprastin, calcium chloride). Simultaneously with antibiotics prescribed vitamins (B1, B2, B6), vitamin C and PP.
    The success of treatment of cholera depends not only on early and rational use of complex medicines, but also from the constant susceptibility of pathogens to the input antibiotics, bacteriophage and sulfanilamidam. If necessary, resort to change from one drug to the other, changes in the mode of introduction and selection of the appropriate doses taking into account the patient's condition, illness and portable products.
    Vibrio bacteriophage meet in the first hours of the disease through the mouth (25 ml) daily for three days. Through the mouth bacteriophage appointed with an equal volume of 2% solution of baking soda.
    Means of pathogenetic therapy to combat dehydration, desalting and symptoms of toxicosis used immediately after hospitalization of the patient. Widely used intravenous infusion pre-heated (up to 40 - 42 degrees) isotonic (0,85%) and hypertension (10%) sodium chloride solutions, physiological solution, ringer type. Isotonic and ringer solution is prescribed in the amount of up to 2-2,5 l per injection and repeat several times a day. At the same time introducing a 5% glucose solution, 500 ml subcutaneously or intravenously 2-4 liters per day. All solutions are better prepared in the Aqua bidestillata. To reduce acidosis in order to increase the alkalinity of the blood is recommended (N. N. Strad Omsk) intravenous infusion Sol. Natrii carbonici purissimi of 1.5-3% at 0.5 to 1 liter In severe cases shown plasma up to 500 ml, dissolved in half with saline solution. Recommended also hydrolysis, aminoatil, polivinol, polyvinyl-pyrrolidon, especially poliglyukin in doses of 200 to 1000 ml per injection.
    A patient with a severe cholera needs special care, warming (heaters, baths, oxygen, appointment
    he individual post and in the appropriate food: dairy, pureed and enveloping meals, drink plenty of water, vitamins. Due to the weakening of cardiovascular activity shows the use of cardiovascular funds (epinephrine, ephedrine, kordiamin, strofantin, camphor, caffeine). In napochechnikova failure appointed steroid drugs (prednisone, prednisolone, dexamethasone, hydrocortisone, and others).

    Prevention. Important obsecenities activities: protection of sources of water supply, sanitary supervision over the preparation, storage and sale of food products at enterprises of public catering, fighting flies, removal and disposal of sewage and garbage, instilling sanitary skills to the population. The decisive role belongs to the measures of sanitary protection of territory of the USSR from the delivery of cholera from abroad and its distribution (see Sanitary protection of the territory).
    At occurrence of diseases cholera requires early detection and isolation of patients. In the hearth of cholera regularly HOMESTEAD rounds to identify and immediate hospitalization in a specially created isolated hospitals of all persons suffering from gastrointestinal disorders. Patients with a diagnosis of cholera are translated into Vibrio hospital. Persons who come into contact with patients with cholera, also isolated in special premises (isolators), which perform bacteriological examination and emergency antibiotic prophylaxis. In special hospitals observed the necessary anti-epidemic regime.
    Persons traveling outside of the hearth, previously sent to observator for a period of maximum incubation period (5 days), where it is carried out once bacteriological examination (see Observation).
    Epidemic indications for use horarnoy the vaccine. It is injected, starting at 2 years of age, subcutaneously twice with an interval of 7-10 days. Adult - 1.0 ml for the first vaccinations and 1.5 ml for a second, children 2-5 years, respectively, 0.3 ml to 0.5 ml 5-10 years - 0.5 ml, and 0.7 ml, 10-15 years old - 0.7 ml, and 1.0 ml Revaccination is carried out after 6 months. dose of the first vaccination.