Dawaa Reference

infectious

Cholera (Suspected / Secretory Diarrhoea)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

WHO Cholera Outbreak Guidelines 2023 · CDC Yellow Book 2024

Verified against3 documents
  • WHO Cholera Outbreak Guidelines 2023
  • Cholera (Vibrio cholerae Infection) - disease-level clinical article (cholera-suspected-clinical.txt)
  • MSF Essential Drugs 2024

Verified date2026-08

Presentation reference

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

Scores

  • WHO dehydration classification (child with diarrhoea) — How dehydrated is this child, and which rehydration plan?

SourceStatPearls "Cholera (Vibrio cholerae Infection)" - disease-level clinical article

Presentation findings are traced to the source above.

1

ORS

1st line

Formoral.liquid

Adult dose and duration

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)

Paediatric dose

Rehydrate with 75 mL/kg over 4 hours, then replace ongoing purging losses (10-20 mL/kg per loose stool)

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
GLUCOHYDRAN 10 SACHET.ARAB DRUG COMPANY (ADCO)1.75 EGP
REHYDRAN N 10 SACHETCID4.50 EGP
REHYDRO ZINC 10 SACHETSCID7.00 EGP
ORS 20 SACHETSPHAROPHARMA40.00 EGP
ELECTRO MASH SYRUP 200 MLMASH PREMIERE60.00 EGP
FLEXOLYTE ORAL REHYDRATION SOL. 240 MLKEMPETRO FOR CHEMICAL INDUSTRIES65.00 EGP
HERO ORS 200 MLHERO > HERO MEA TRADING120.00 EGP
SANSO ORS SYRUP 140 MLAUG PHARMA400.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose 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.

Cautions
  • RED FLAG - Emergent intravenous rehydration is required for severe dehydration or hypovolemic shock.
3

DOXYCYCLINE

add-on - not a substitute

Strength100 mg

Formoral.solid

Adult dose and duration

300 mg single dose - single dose

Paediatric dose

Single dose: 2-4 mg/kg (max 300 mg) for children >=8 years; for <8 years give Azithromycin 20 mg/kg single dose

Dose source

WHO Cholera Outbreak Guidelines 2023

Why

Single-dose antibiotic therapy reduces stool volume and duration of Vibrio cholerae shedding

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)
4

AZITHROMYCIN

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1000 mg single dose - single dose

Paediatric dose

20 mg/kg/dose [child max 1000 mg]

(20 mg/kg single dose (max 1000 mg) in children)

Dose by weight
3kg60 mg/dose
4kg80 mg/dose
5kg100 mg/dose
6kg120 mg/dose
7kg140 mg/dose
8kg160 mg/dose
9kg180 mg/dose
10kg200 mg/dose
11kg220 mg/dose
12kg240 mg/dose
13kg260 mg/dose
14kg280 mg/dose
15kg300 mg/dose
16kg320 mg/dose
17kg340 mg/dose
18kg360 mg/dose
19kg380 mg/dose
20kg400 mg/dose
21kg420 mg/dose
22kg440 mg/dose
23kg460 mg/dose
24kg480 mg/dose
25kg500 mg/dose
26kg520 mg/dose
27kg540 mg/dose
28kg560 mg/dose
29kg580 mg/dose
30kg600 mg/dose
31kg620 mg/dose
32kg640 mg/dose
33kg660 mg/dose
34kg680 mg/dose
35kg700 mg/dose
36kg720 mg/dose
37kg740 mg/dose
38kg760 mg/dose
39kg780 mg/dose
40kg800 mg/dose
41kg820 mg/dose
42kg840 mg/dose
43kg860 mg/dose
44kg880 mg/dose
45kg900 mg/dose
46kg920 mg/dose
47kg940 mg/dose
48kg960 mg/dose
49kg980 mg/dose
50kg1000 mg/dose
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Choice

Azithromycin is the first choice here; zinc sulfate is a further option.

Dose source

WHO Cholera Outbreak Guidelines 2023

Why

Preferred antibiotic for pregnant women and children under 8 years

Cautions
  • Azithromycin is the first-line antibiotic choice in pregnant women and young children.
  • Take on empty stomach if tolerated.
Egyptian brands
Egyptian brandManufacturerIndicative price
AZATRIBACT 500MG 3 CAPS.RIVA PHARMA S.A.E.13.50 EGP (4.50/unit)
GIGAZOCIN 500MG 5 CAPS.EGPI > PIONEER27.50 EGP (5.50/unit)
SYSTYMYCIN 500MG 3 CAPS.EGPI > NOVELL PHARMA21.50 EGP (7.17/unit)
AZITHROMASH 500 MG 3 F.C. TABS.MASH PREMIERE48.00 EGP (16.00/unit)
AZALIDE 500MG 3 CAPS.UP PHARMA52.00 EGP (17.33/unit)
AZROLID 500 MG 6 F.C.TABS.AMRIYA126.00 EGP (21.00/unit)
ZERAMERATE 500 MGEGPI > GAMMA PHARMA28.50 EGP
DISTABCIN 500 MG 3 DISPERSIBLE TABS.EGPI43.50 EGP
ZITHRODOSE 100MG/5ML SUSP. 15ML? strength differs? different route - not oral solidEL-OBOUR > AVERROES PHARMA-EGYPT12.00 EGP
ZITHROPHATE 200MG/5ML SUSP. 15ML? strength differs? different route - not oral solidORGANO PHARMA > NOVELL PHARMA12.75 EGP
5

ZINC SULFATE

add-on - not a substitute

Formoral.liquid

Adult dose and duration

Child under 6 months: 10 mg once daily for 10 days; Child 6 months to 5 years: 20 mg once daily x 10 days

Paediatric dose

(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).)

Dose by age
Under 6 months:10 mg once daily for 10 days
6 months to 5 years:20 mg once daily for 10 days
Dose source

MSF Essential Drugs 2024

Why

Paediatric micronutrient adjunct to oral rehydration solution to reduce duration and severity of acute cholera diarrhoea.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
ZINC SULFATE 10MG/5ML POWDER FOR SYRUPCID5.00 EGP
SALFOVEROSE 20MG/5ML SYRUP 120MLAVERROES PHARMA-EGYPT11.70 EGP
ZINCORHEA SYRUP 80 MLPHARCO15.50 EGP
SULFOZINC 10MG/5ML PD. FOR SUSP. 80MLCID22.00 EGP
SULFOZINC 20MG/5ML SYRUP 80MLCID24.00 EGP
ZINCOMIST 10MG/5ML SYRUP 120 MLORCHIDIA50.00 EGP
AGNATIX SYRUP 60 MLORGANIX > INNOVAKA59.00 EGP
ZINCOMEZ 120 ML SYRUPORGANIX > MEZ PHARMA85.00 EGP
ZINC-SEDICO 10MG/5ML PD. FOR ORAL SOL.? strength differs? different route - not oral liquidSEDICO7.00 EGP
ZINC-SEDICO 20MG/5ML PD. FOR ORAL SOL.? strength differs? different route - not oral liquidSEDICO8.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.