Cholera
Also called: Vibrio cholerae infection, acute watery diarrhoea (cholera)
Cholera is a bowel infection caught from dirty water or food. It can cause sudden, heavy watery diarrhoea and vomiting that dry the body out within hours. Quick rehydration with ORS, and a drip in severe cases, saves almost every life.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Cholera is an infection of the small intestine (the first part of the bowel) caused by a germ called Vibrio cholerae. The germ makes a toxin (poison) that pulls water out of the body into the gut. This leads to large amounts of watery diarrhoea. People catch it by drinking water or eating food that has traces of faeces (stool) from an infected person.
Most people who swallow the germ have no symptoms or only mild diarrhoea. About one in ten become severely ill. Symptoms usually start between 12 hours and 5 days after infection. Severe cholera can cause dangerous dehydration (loss of body water and salts) and shock, and can kill within hours if it is not treated. People without symptoms can still pass the germ in their stool for 1 to 10 days.
Cholera spreads where drinking water and sewage are not treated properly, and outbreaks often follow floods, crowding, conflict and displacement. The good news is that treatment is simple. Replacing lost fluid with oral rehydration solution (ORS), and with fluids through a drip for the most severe cases, means more than 99 out of 100 patients survive. Clean water, safe toilets, handwashing and vaccination prevent it.
In Pakistan
In the early-summer 2022 cholera outbreak in Karachi, all germs tested at one large hospital were Vibrio cholerae O1 Ogawa and all were still killed by tetracycline, doxycycline, azithromycin and ciprofloxacin, but about three in four were resistant to co-trimoxazole and one in four to ampicillin. The authors called for better disinfection of drinking water, sanitation and sewage disposal in the city.
Symptoms
- Sudden, heavy watery diarrhoea, sometimes with a fishy smell
- Feeling sick (nausea) and vomiting
- Stomach cramps
- Leg cramps
- Strong thirst, dry mouth and dry skin
- Sunken eyes and no tears
- Passing little or no urine
- Fast heartbeat
- Restlessness, unusual tiredness or sleepiness
- In babies, a sunken soft spot (fontanelle) on the head
Causes and risk factors
Causes
- Infection with the bacterium Vibrio cholerae (groups O1 and O139); O1 causes almost all recent outbreaks
- Drinking water that is contaminated with faeces from an infected person
- Eating food washed or prepared with unsafe water, or handled with unwashed hands
- Eating raw or undercooked shellfish from coastal or brackish water where the germ lives
What makes it more likely
- Living in or travelling to an area with a cholera outbreak
- No access to safe drinking water
- Poor sanitation and open sewage
- Not washing hands with soap
- Floods, cyclones or drought that damage water supplies
- Crowded camps after conflict or displacement
- Having other illnesses (comorbidities), which can make the disease harder to manage
Complications
The main danger of cholera is very fast loss of water and salts from the body. Without treatment, severe dehydration can lead to shock (a drop in blood flow to the organs), and death can follow within hours. People with other health problems may need care in a special treatment centre. The acid balance of the blood can also be upset, which is why proper ORS or the right drip fluid is needed rather than plain sugar water. With early and correct rehydration, even very sick patients usually recover fully.
When to see a doctor
- Heavy watery diarrhoea that keeps coming, especially during an outbreak: get medical help at once
- Signs of severe dehydration: very dry mouth, little or no urine, sunken eyes, skin that goes back very slowly when pinched
- A weak or fast pulse, cold hands, or feeling faint
- Very sleepy, confused, hard to wake or unconscious (emergency)
- Vomiting so much that ORS cannot be kept down
- A baby or young child with watery diarrhoea who is drowsy, not feeding or has a sunken soft spot
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Diagnosis
During an outbreak, doctors usually diagnose cholera from the symptoms: sudden, heavy watery diarrhoea with vomiting in someone from an affected area. Treatment should never wait for a test result. The first and most important step is to check how dehydrated the person is, by looking at thirst, alertness, eyes, mouth, pulse, urine and how quickly pinched skin goes back.
Tests confirm the germ and help track outbreaks. Rapid diagnostic tests on stool are used for early detection in the community. A laboratory can confirm cholera with a stool culture, or with a stool PCR test (a test that finds the germ's genetic material) that checks for several diarrhoea germs at once. A blood culture may sometimes be done. Laboratory testing also shows which antibiotics still work against the local germ.
Treatment
- Start ORS straight away if cholera is suspected, even on the way to a clinic, mixed with boiled or treated water
- Most people with mild or moderate cholera recover with ORS alone; take frequent small sips if vomiting
- Severe dehydration needs fast fluids through a drip in hospital, with ORS restarted as soon as the person can drink
- Antibiotics are added for people who are moderately or severely ill, or admitted to hospital, always together with rehydration; they shorten the illness. Your doctor chooses the medicine and the dose
- Children aged 6 months to 5 years should also be given zinc when available
- Keep breastfeeding or formula feeding babies throughout the illness
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Oral rehydration salts (ORS) | first and most important treatment; replaces lost water and salts and is enough for most mild and moderate cases; must be mixed with safe water | Oral rehydration salts (low-osmolarity), Oral rehydration salts (ORS) (10 brands) |
| Intravenous fluids (drip) | for severe dehydration, shock, uncontrollable vomiting or reduced consciousness; Ringer's lactate is the preferred drip fluid; given in hospital | Ringer's lactate solution (15 brands), Ringer's lactate electrolytes (2 brands) |
| Tetracycline antibacterials | first choice antibiotic for non-pregnant adults who are moderately or severely ill; second choice for children; given only alongside rehydration and never to people without symptoms | Doxycycline (80 brands), Tetracycline (2 brands) |
| Macrolide antibacterials | first choice antibiotic for children and pregnant women, and an alternative for adults; your doctor decides which one and the dose | Azithromycin (662 brands), Erythromycin (11 brands) |
| Zinc supplements | for children aged 6 months to 5 years with cholera, started early alongside ORS; helps shorten diarrhoea; doctor decides the dose | Zinc (62 brands), Zinc sulfate (19 brands) |
| Oral cholera vaccine | prevention; used in outbreak campaigns and for people living in or travelling to affected areas; can be given to anyone over one year old and is safe in pregnancy | Oral cholera vaccine (1 brand), Cholera vaccine (inactivated, oral; Vibrio cholerae O1 and O139) (1 brand), Cholera vaccine (inactivated whole-cell + recombinant B-subunit), oral (1 brand) |
Self-care and prevention
Self-care
- Start ORS at the first sign of watery diarrhoea and keep drinking it in small, frequent sips
- Make ORS only with boiled or chlorine-treated water and follow the packet instructions
- If ORS is not available, drink safe water or broth while you get to a clinic
- Avoid sugary drinks such as juice, soft drinks and sports drinks, which can make diarrhoea worse
- Keep breastfeeding babies, or keep giving formula
- Do not take other diarrhoea or anti-vomiting medicines unless a doctor gives them
- Wash hands with soap after using the toilet and after caring for a sick person
Prevention
- Drink only boiled, chlorinated or otherwise treated water
- Wash hands with soap and safe water before eating or cooking and after the toilet
- Use a toilet or latrine and dispose of faeces safely
- Prepare and store food safely with clean water, and avoid raw shellfish
- Get the oral cholera vaccine when it is offered in an outbreak campaign or before travel to an affected area
- Mass use of antibiotics to prevent cholera is not recommended
Common questions
Is cholera contagious?
Cholera does not usually spread through casual contact such as shaking hands. It spreads when faeces from an infected person get into drinking water or food. People with no symptoms can still pass the germ in their stool for several days, so handwashing and safe toilets matter for everyone.
Can cholera be treated at home?
Mild and moderate cholera is treated mainly with ORS, and this should be started at home straight away. Still, see a doctor or go to a treatment centre quickly, because dehydration can become severe within hours. Anyone who is very weak, drowsy or cannot keep fluids down needs a drip in hospital.
Does everyone with cholera need antibiotics?
No. Fluids are the life-saving treatment. Antibiotics are given to people who are moderately or severely ill or admitted to hospital, always together with rehydration, and they shorten the illness. They are not given to people without symptoms, and giving them to whole communities to prevent cholera is not recommended because it encourages resistance.
Is the cholera vaccine safe, and who can have it?
The oral cholera vaccines approved by WHO are swallowed, not injected, and the main campaign vaccines can be given to anyone over one year old. WHO says the vaccine is safe in pregnancy. Even after vaccination, you still need safe water, safe food and handwashing.
Can I breastfeed if my baby or I have cholera?
Yes. Babies with watery diarrhoea should keep breastfeeding, or keep taking formula, to help stay hydrated. ORS is given as well, as advised by the health worker.
Sources
- WHO (fact sheet). Cholera (2024).
- CDC. Treating Cholera | Cholera | CDC (2025).
- CDC. Cholera | Cholera | CDC (2025).
- CDC. Defeating Cholera: Clinical Presentation and Management for Haiti Cholera Outbreak, 2010 (n.d.).
- MedlinePlus. Cholera: MedlinePlus Medical Encyclopedia (2026).
- Journal of the College of Physicians and Surgeons Pakistan. Cholera Outbreak 2022 in Karachi: A Report on Serotype and Antibiotic Susceptibility Pattern (2022).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
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