Background: The World Health Organization (WHO) Guidelines for Cholera Control were prepared by the WHO's Global Task Force on Cholera Control and published in 1993. The proposed activities are implemented throughout the world, though the basis of the guidelines, namely expert opinions, are ranked at the lowest level in the hierarchy of evidence. Cholera remains a major threat and every developing country needs to be prepared to cope effectively with a cholera outbreak or an epidemic. Objectives: To identify which aspects of the WHO Guidelines for Cholera Control are evidence based.

Methods: We have selected from the guidelines some of the recommendations for dealing with cholera in the field. These recommendations relate to the management of the patient with cholera (rehydration therapy, antibiotic treatment, symptomatic treatment, breast-feeding) and to the prevention in the spread of an outbreak (mass chemoprophylaxis, selective chemoprophylaxis, travel and trade restriction, i.e. cordon sanitaire, and vaccination). Search Strategy and Selection: We searched various databases; including Medline, The Cochrane Database of Systematic Reviews and Best Evidence for reviews, descriptive and analytical studies (intervention and observational). We have included studies relevant to the research questions and written in Spanish and English. We have evaluated their quality and collected the best evidence available for the WHO recommendations.

Results: The results show a varied level of evidence for the different recommendations made in the WHO Guidelines for Cholera Control.

Conclusions: Our review concludes that the guidelines should be revised on the basis of existing evidence and that clinical trials in epidemic situation need to be undertaken to establish the optimum management strategies. Donors financing cholera interventions in developing countries should support research activities that would help provide the evidence of effective and efficient cholera interventions.