This protocol covers children under 18 years who have cholera together with Severe Acute Malnutrition (SAM) and whose dehydration and watery stools have not been controlled after first-line management. Malnourished children with cholera are at risk of complications and death and require a carefully adapted approach.
The patient is a child under 18 years with concurrent cholera and Severe Acute Malnutrition (SAM). Patients with coexisting conditions such as SAM carry heightened risk regardless of the apparent degree of dehydration.
First-line management — treatment at a Cholera Treatment Unit or Centre, standard oral rehydration, continued breastfeeding and therapeutic feeding, and a single-dose antibiotic (Doxycycline, Azithromycin, or Ciprofloxacin) — did not achieve the expected goals: no signs of dehydration and cessation of watery stools.
When severe dehydration persists despite initial oral management, the protocol calls for an IV-based rehydration strategy specifically adapted for malnourished children, alongside continued nutritional support throughout. The complete pathway and clinical criteria are detailed in the full protocol.
Clinical goal: Resolution of dehydration