# Cholera (Suspected / Secretory Diarrhoea) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: WHO Cholera Outbreak Guidelines 2023 · CDC Yellow Book 2024 - Verified date: 2026-08 ## Verified against - WHO Cholera Outbreak Guidelines 2023 - Cholera (Vibrio cholerae Infection) - disease-level clinical article (cholera-suspected-clinical.txt) - MSF Essential Drugs 2024 ## Treatment metadata - ORS — oral.liquid - Referral & safety-netting (no drug therapy) - Doxycycline — 100 mg — oral.solid - Azithromycin — 500 mg — oral.solid - Zinc sulfate — oral.liquid ## Complete treatment card ```text CHOLERA (SUSPECTED / SECRETORY DIARRHOEA) Sources: WHO Cholera Outbreak Guidelines 2023 · CDC Yellow Book 2024 Review status: REVIEWED against WHO Cholera Outbreak Guidelines 2023, Cholera (Vibrio cholerae Infection) - disease-level clinical article (cholera-suspected- clinical.txt), MSF Essential Drugs 2024 (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Heavy, painless watery diarrhea and vomiting without a fever is the typical picture, though severity varies widely [diarrhoea · vomiting] - The classic stool is watery with a foul smell and flecks of mucus, described as rice-water stool - In the severe form, hypotensive shock can set in within hours and death can follow without prompt treatment; mortality has reached as high as 70% in reports [shock] - A dry variant causes fluid to pool inside the gut, leading to collapse and death even before diarrhea appears [collapse · diarrhoea] - Muscle cramping and weakness can result from the electrolyte losses of the illness [muscle cramps] - Losing around 3 to 5% of body weight in fluid brings on marked thirst SIGNS - what you find (3) - Shock from fluid loss can show as low urine output, cool clammy skin, poor skin tenting, sunken eyes, and deep acidotic breathing [dehydration · shock · sweating] - At around 5 to 8% fluid loss, exam shows a drop in blood pressure on standing, weakness, a fast pulse, tiredness, and dry mucous membranes [dehydration · fatigue] - Beyond about 10% fluid loss, exam shows minimal urine, a weak or absent pulse, sunken eyes, wrinkled skin, and drowsiness progressing toward coma [absent pulse · coma · dehydration · drowsiness] TESTS (6) - Labs commonly show low potassium, low calcium, metabolic acidosis, and sodium levels that track with the fluid loss - Children can develop severe low blood sugar with confusion, seizures, or coma - No fixed lab or imaging result is required to diagnose or manage the illness - Stool culture remains the reference test for confirming the organism but takes too long for urgent decisions - Treatment should start on clinical grounds and never wait on lab confirmation - Bedside dipstick-style tests are cheap and fast for field use, but are not considered reliable enough for routine point-of-care diagnosis IF NOT THIS - what else fits (4) - In young children living where the illness is common, giardia, rotavirus, and cryptosporidium are frequent alternative causes - In older children and adults in the same settings, toxin-producing E coli is a common alternative cause - Other watery-diarrhea causes to weigh include toxin-producing E coli, other cholera serogroups, Campylobacter, nontyphoidal Salmonella, Aeromonas, norovirus, adenovirus, and rotavirus - Bloody diarrhea instead points toward Shigella, Campylobacter, invasive or hemorrhagic E coli, nontyphoidal Salmonella, amoebae, or schistosomiasis Score WHO dehydration classification (child with diarrhoea) - How dehydrated is this child, and which rehydration plan? Source StatPearls "Cholera (Vibrio cholerae Infection)" - disease-level clinical article Status traced to the source above 1. ORS [1st line] Adult Reconstitute 1 sachet in 1 L clean water; drink 1000 mL/hour in severe fluid loss until rehydrated, then replace ongoing stool losses volume-for-volume - Until diarrhoea ceases (usually 3-5 days) Peds Rehydrate with 75 mL/kg over 4 hours, then replace ongoing purging losses (10-20 mL/kg per loose stool) Source WHO Cholera Outbreak Guidelines 2023 Why Oral rehydration solution replaces the massive fluid and electrolyte losses of the secretory diarrhoea caused by cholera; rehydration is itself the life-saving treatment here, not an adjunct to one. Caution LIFE-SAVING FIRST LINE: Oral rehydration salts reduce mortality from 50% to <1%. Severe dehydration with shock requires IMMEDIATE IV Ringer's Lactate fluid resuscitation. Report suspect cases immediately to public health authorities. Egypt GLUCOHYDRAN 10 SACHET. ARAB DRUG COM... 1.75 EGP REHYDRAN N 10 SACHET CID 4.50 EGP REHYDRO ZINC 10 SACHETS CID 7.00 EGP ORS 20 SACHETS PHAROPHARMA 40.00 EGP ELECTRO MASH SYRUP 200 ML MASH PREMIERE 60.00 EGP FLEXOLYTE ORAL REHYDRATION SOL. 240 ML KEMPETRO FOR CHEMICAL INDUSTRIES 65.00 EGP HERO ORS 200 ML HERO > HERO M... 120.00 EGP SANSO ORS SYRUP 140 ML AUG PHARMA 400.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Cholera (Vibrio cholerae Infection) - disease-level clinical article (cholera-suspected- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Emergent intravenous rehydration is required for severe dehydration or hypovolemic shock. 3. DOXYCYCLINE [add-on - not a substitute] Adult 300 mg single dose - single dose Peds Single dose: 2-4 mg/kg (max 300 mg) for children >=8 years; for <8 years give Azithromycin 20 mg/kg single dose Source WHO Cholera Outbreak Guidelines 2023 Why Single-dose antibiotic therapy reduces stool volume and duration of Vibrio cholerae shedding Caution Antibiotics are ADJUNCT to fluid replacement, never a substitute. Contraindicated in pregnancy and children <8 years (use Azithromycin instead). The Egyptian National Drug Formulary - Antimicrobial 2023, doxycycline monograph, sets the same limit: under 8 years the drug is held back for infections that are severe or potentially life-threatening, or for when there is no better alternative to hand. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) 4. AZITHROMYCIN [add-on - not a substitute] Adult 1000 mg single dose - single dose Peds 20 mg/kg/dose [child max 1000 mg] (20 mg/kg single dose (max 1000 mg) in children) 3kg -> 60 mg/dose 4kg -> 80 mg/dose 5kg -> 100 mg/dose 6kg -> 120 mg/dose 7kg -> 140 mg/dose 8kg -> 160 mg/dose 9kg -> 180 mg/dose 10kg -> 200 mg/dose 11kg -> 220 mg/dose 12kg -> 240 mg/dose 13kg -> 260 mg/dose 14kg -> 280 mg/dose 15kg -> 300 mg/dose 16kg -> 320 mg/dose 17kg -> 340 mg/dose 18kg -> 360 mg/dose 19kg -> 380 mg/dose 20kg -> 400 mg/dose 21kg -> 420 mg/dose 22kg -> 440 mg/dose 23kg -> 460 mg/dose 24kg -> 480 mg/dose 25kg -> 500 mg/dose 26kg -> 520 mg/dose 27kg -> 540 mg/dose 28kg -> 560 mg/dose 29kg -> 580 mg/dose 30kg -> 600 mg/dose 31kg -> 620 mg/dose 32kg -> 640 mg/dose 33kg -> 660 mg/dose 34kg -> 680 mg/dose 35kg -> 700 mg/dose 36kg -> 720 mg/dose 37kg -> 740 mg/dose 38kg -> 760 mg/dose 39kg -> 780 mg/dose 40kg -> 800 mg/dose 41kg -> 820 mg/dose 42kg -> 840 mg/dose 43kg -> 860 mg/dose 44kg -> 880 mg/dose 45kg -> 900 mg/dose 46kg -> 920 mg/dose 47kg -> 940 mg/dose 48kg -> 960 mg/dose 49kg -> 980 mg/dose 50kg -> 1000 mg/dose AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Choice Azithromycin is the first choice here; zinc sulfate is a further option. Source WHO Cholera Outbreak Guidelines 2023 Why Preferred antibiotic for pregnant women and children under 8 years Caution Azithromycin is the first-line antibiotic choice in pregnant women and young children. Take on empty stomach if tolerated. Egypt AZATRIBACT 500MG 3 CAPS. RIVA PHARMA S... 13.50 EGP (4.50/unit) GIGAZOCIN 500MG 5 CAPS. EGPI > PIONEER 27.50 EGP (5.50/unit) SYSTYMYCIN 500MG 3 CAPS. EGPI > NOVELL... 21.50 EGP (7.17/unit) AZITHROMASH 500 MG 3 F.C. TABS. MASH PREMIERE 48.00 EGP (16.00/unit) AZALIDE 500MG 3 CAPS. UP PHARMA 52.00 EGP (17.33/unit) AZROLID 500 MG 6 F.C.TABS. AMRIYA 126.00 EGP (21.00/unit) ZERAMERATE 500 MG EGPI > GAMMA ... 28.50 EGP DISTABCIN 500 MG 3 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid 5. ZINC SULFATE [add-on - not a substitute] Adult Child under 6 months: 10 mg once daily for 10 days; Child 6 months to 5 years: 20 mg once daily x 10 days Peds Under 6 months: 10 mg once daily for 10 days 6 months to 5 years: 20 mg once daily for 10 days (Child under 6 months: 10 mg once daily for 10 days. Child from 6 months to 5 years: 20 mg once daily for 10 days (MSF Essential Drugs 2024, zinc sulfate monograph p.339).) Source MSF Essential Drugs 2024 Why Paediatric micronutrient adjunct to oral rehydration solution to reduce duration and severity of acute cholera diarrhoea. Caution Zinc deficiency impairs appetite and immune recovery. Give between meals for optimal absorption. Complete the full 10-day course even after the diarrhoea stops. Egyptian products are zinc sulfate syrups, not the dispersible tablet the guideline describes. Give the stated milligram dose, measured from the strength printed on the bottle. Egypt ZINC SULFATE 10MG/5ML POWDER FOR SYRUP CID 5.00 EGP SALFOVEROSE 20MG/5ML SYRUP 120ML AVERROES PHAR... 11.70 EGP ZINCORHEA SYRUP 80 ML PHARCO 15.50 EGP SULFOZINC 10MG/5ML PD. FOR SUSP. 80ML CID 22.00 EGP SULFOZINC 20MG/5ML SYRUP 80ML CID 24.00 EGP ZINCOMIST 10MG/5ML SYRUP 120 ML ORCHIDIA 50.00 EGP AGNATIX SYRUP 60 ML ORGANIX > INN... 59.00 EGP ZINCOMEZ 120 ML SYRUP ORGANIX > MEZ... 85.00 EGP ZINC-SEDICO 10MG/5ML PD. FOR ORAL SOL. SEDICO 7.00 EGP -> ? strength differs, ? different route - not oral liquid ZINC-SEDICO 20MG/5ML PD. FOR ORAL SOL. SEDICO 8.00 EGP -> ? strength differs, ? different route - not oral liquid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)