From the Guidelines
Antibiotic treatment is recommended for severe bacterial food poisoning caused by specific bacteria, including Shigella, Campylobacter, and certain strains of E. coli, with azithromycin being the preferred treatment option due to its efficacy and safety profile, as supported by the most recent and highest quality study 1.
Key Considerations for Antibiotic Treatment
- The decision to treat with antibiotics should be based on the severity of illness, the presence of bloody diarrhea, and the patient's travel history and susceptibility patterns.
- Azithromycin is recommended as the first-line treatment for dysentery and acute watery diarrhea with fever, due to its efficacy against Shigella, Campylobacter, and other bacterial causes.
- Fluoroquinolones, such as ciprofloxacin, may be considered as an alternative treatment option, but their use is limited by concerns about resistance and potential side effects.
Treatment Options
- Azithromycin: 500mg once daily for 3 days, or a single 1-gm dose, is recommended for the treatment of severe bacterial food poisoning caused by Shigella, Campylobacter, and certain strains of E. coli.
- Ciprofloxacin: 500mg twice daily for 3-5 days, may be considered as an alternative treatment option, but its use should be guided by local susceptibility patterns and travel history.
Important Considerations
- Antibiotics should not be used to treat food poisoning caused by Shiga toxin-producing E. coli, as they can worsen the condition.
- Antidiarrheal medications, such as loperamide, should be avoided in severe bacterial infections, as they can prolong the infection.
- Rest, rehydration, and a gradual return to eating with bland, easy-to-digest foods are essential for recovery from severe bacterial food poisoning.
From the FDA Drug Label
Gram-positive bacteria Staphylococcus aureus Streptococcus agalactiae Streptococcus pneumoniae Streptococcus pyogenes Gram-negative bacteria Haemophilus ducreyi Haemophilus influenzae Moraxella catarrhalis Neisseria gonorrhoeae “Other” bacteria Chlamydophila pneumoniae Chlamydia trachomatis Mycoplasma pneumoniae
The types of food poisoning that may require antibiotic treatment include those caused by:
- Gram-positive bacteria: Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes
- Gram-negative bacteria: Haemophilus ducreyi, Haemophilus influenzae, Moraxella catarrhalis, Neisseria gonorrhoeae
- Other bacteria: Chlamydophila pneumoniae, Chlamydia trachomatis, Mycoplasma pneumoniae However, the FDA drug label does not directly answer the question of which types of food poisoning require antibiotic treatment. 2 2
From the Research
Types of Food Poisoning Requiring Antibiotic Treatment
- Severe bacterial food poisoning may require antibiotic treatment, especially in high-risk patients such as the elderly, immunocompromised, diabetes, liver cirrhosis, or intestinal hypomotility 3
- Antibiotics such as azithromycin, ceftriaxone, ciprofloxacin, and amoxicillin are commonly used to treat bacterial food poisoning, including Salmonella and Shigella infections 4, 5
Antibiotic Treatment for Specific Bacterial Infections
- Azithromycin is an effective treatment for uncomplicated Salmonella Typhi infection, but may be associated with delayed treatment response and prolonged bacteraemia compared to ciprofloxacin 6
- Azithromycin is a good alternative treatment option for Salmonella and Shigella infections, with low resistance rates reported in some studies 4, 7
- Ciprofloxacin is also effective in treating Salmonella infection, but is not approved for use in children 5
Considerations for Antibiotic Treatment
- The choice of antibiotic treatment should be based on the severity of the infection, the patient's underlying health conditions, and the susceptibility of the bacteria to the antibiotic 3, 5
- Antibiotic resistance is a growing concern, and the use of antibiotics should be judicious and guided by antimicrobial susceptibility testing 7