What are the common prescription treatments for food poisoning in India?

Common Prescription Treatments for Food Poisoning in India

Azithromycin is the first-line antibiotic treatment for food poisoning in India, especially for cases with dysentery or fever, due to high rates of fluoroquinolone resistance in the region. 1

Diagnosis and Classification

Food poisoning (foodborne illness) presents with:

• Nausea and vomiting
• Diarrhea (watery or bloody)
• Abdominal pain and cramps
• Fever

Treatment depends on severity:

• Mild: Watery diarrhea without fever
• Moderate: Frequent diarrhea affecting daily activities
• Severe: Dysentery (bloody diarrhea), high fever, or dehydration

First-Line Treatments

1. Oral Rehydration Therapy

• Primary treatment for all cases of food poisoning
• Use properly formulated oral rehydration solution (ORS)
• Continue age-appropriate feeding throughout illness

2. Antimicrobial Therapy

For Watery Diarrhea (Non-dysenteric):

• Azithromycin:

  • Adults: 1 gram single dose OR 500 mg daily for 3 days
  • Children: 30 mg/kg as a single dose 1, 2

• Alternative options (if susceptibility confirmed):

  • Ciprofloxacin: 500 mg twice daily for 3 days or single 750 mg dose
  • Levofloxacin: 500 mg daily for 3 days
  • Rifaximin: 200 mg three times daily for 3 days 1

For Dysentery (Bloody Diarrhea):

• Azithromycin (first-line): Same dosing as above 1, 2
  • Particularly important due to high fluoroquinolone resistance rates (>85%) in South Asia 2

For Specific Pathogens:

Shigellosis:

• First-line: Azithromycin 500 mg daily for 5 days
• Alternatives (based on susceptibility):
  • Ampicillin: 500 mg four times daily for 5 days
  • TMP-SMX: 160/800 mg twice daily for 5 days
  • Nalidixic acid: 55 mg/kg/day in four divided doses for 5 days 1

Campylobacter:

• First-line: Azithromycin 500 mg daily
• Alternative: Fluoroquinolones (only if susceptibility confirmed) 1, 2

Amebiasis:

• Metronidazole: 750 mg three times daily for 5-10 days 1

Giardiasis:

• Metronidazole: 250 mg three times daily for 5 days 1

Symptomatic Treatment

Anti-motility Agents

• Loperamide: 4 mg initially, then 2 mg after each loose stool (maximum 16 mg/day) 1
• Caution: Avoid in dysentery or severe inflammatory diarrhea 2

Special Populations

Immunocompromised Patients

• Lower threshold for antibiotic treatment
• Consider longer treatment courses
• Monitor for worsening symptoms 2

Children

• Azithromycin is preferred (30 mg/kg as single dose)
• Avoid antimotility agents in young children 2

Common Pitfalls to Avoid

1. Using fluoroquinolones as first-line therapy: High resistance rates (>85%) in South Asia make azithromycin the preferred choice 1, 2

2. Delaying antibiotic treatment: Most effective when started within 72 hours of symptom onset 2

3. Inappropriate fluid replacement: Using "clear liquids" instead of properly formulated ORS can worsen electrolyte imbalances 2

4. Food restriction during illness: Continue feeding to prevent malnutrition, especially in children 2

5. Overuse of antibiotics: In India, studies show antibiotics are prescribed for 84% of diarrhea cases, despite many being viral in origin 3

Prevention Measures

• Proper hand hygiene
• Avoid raw or undercooked food
• Safe food handling practices
• Clean drinking water

The high prevalence of antimicrobial resistance in India necessitates judicious use of antibiotics and adherence to evidence-based treatment protocols for food poisoning management.