Treatment of Cholera in Children Under 18 with Severe Acute Malnutrition

Clinical Scenario

This protocol covers children under 18 years presenting with confirmed or suspected cholera in the context of severe acute malnutrition (SAM). The concurrent presence of SAM fundamentally changes how cholera is managed — both rehydration and supportive care diverge from standard cholera protocols.

Malnourished children with cholera are at risk of complications and death. Patients with coexisting conditions such as Severe Acute Malnutrition (SAM) require specific management adjustments regardless of the degree of dehydration.

Management Approach

Immediate escalation to a dedicated cholera treatment facility is required. Rehydration in this population follows specific guidance that differs critically from standard SAM rehydration practice, and a single oral antibiotic dose is part of the regimen.

The full structured protocol specifies which rehydration solution to use, what to avoid and why, how to manage feeding throughout treatment, and antibiotic selection for this population.

No signs of dehydration Cessation of watery stools

Instant Access to Structured Evidence-Based Regimens

References

Malnourished children with cholera are at risk of complications and death.

Patients with coexisting conditions (including pregnancy) or comorbidities (such as Severe Acute Malnutrition (SAM), and HIV), regardless of the degree of dehydration

Immediately treat children with SAM and suspected cholera at a CTU/ CTC

For oral rehydration of children with SAM during an outbreak of cholera, give standard ORS

Do not give ReSoMal (Rehydration Solution for Malnutrition) as its sodium content is not sufficient to replace that lost in cholera

Breastfeeding and feeding with therapeutic milk should continue throughout rehydration

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