Treatment of Food Poisoning
The primary treatment for food poisoning is supportive care focused on rehydration and symptom management, with antibiotics reserved only for high-risk patients or specific severe bacterial infections. 1, 2
Immediate Management Priorities
First-Line Supportive Care
- Rehydration is the cornerstone of treatment for all food poisoning cases, as fluid and electrolyte losses from vomiting and diarrhea are the primary cause of morbidity 3, 2
- Oral rehydration is preferred when tolerated; intravenous fluids are indicated for clinically dehydrated patients who cannot maintain oral intake 2
- Monitor for signs of dehydration including decreased urine output, dry mucous membranes, tachycardia, and orthostatic hypotension 2
Symptom Management
- Anti-emetics may be used to control nausea and vomiting in adults 2
- Do not give anything by mouth unless advised by poison control or emergency medical personnel in acute poisoning scenarios 1
- Avoid antidiarrheal agents (like loperamide) in cases with bloody diarrhea or high fever, as they may worsen outcomes in invasive bacterial infections 4, 2
When to Consider Antibiotics
High-Risk Patients Requiring Empiric Therapy
Empiric antibiotic therapy should be considered in the following high-risk populations: 3, 2
- Elderly patients
- Immunocompromised individuals (including HIV/AIDS, transplant recipients, chemotherapy patients)
- Patients with diabetes mellitus
- Patients with liver cirrhosis
- Patients with intestinal hypomotility disorders
Clinical Indicators for Antibiotic Use
- Bloody diarrhea with fever suggesting invasive bacterial infection 2
- Severe symptoms with signs of systemic toxicity 2
- Suspected Salmonella, Campylobacter, or Shigella in high-risk patients 2
Important caveat: Most viral foodborne illnesses (like norovirus, the most common cause in the United States) do not benefit from antibiotics and resolve with supportive care alone 2
Specific Decontamination Considerations
Activated Charcoal
- Should NOT be administered routinely in food poisoning cases 5
- May be considered only when a patient has an intact airway and presents soon after ingestion of a known toxic substance 5
- The American Heart Association states there is insufficient evidence to recommend activated charcoal in first aid settings 5
- Never use for caustic substance ingestions (strong acids or bases) as it may cause additional harm 5
What NOT to Do
- Do not induce vomiting with ipecac syrup - this is no longer recommended by the American Heart Association or American Red Cross 5, 1
- Do not perform gastric lavage outside of hospital settings 5
- Avoid giving milk or water for dilution unless specifically directed by poison control 1
When to Seek Emergency Care
Contact emergency medical services or poison control immediately if: 1, 6
- Life-threatening symptoms develop (severe dehydration, altered mental status, seizures)
- Suspected chemical food poisoning rather than microbial contamination 7
- Symptoms persist beyond several days or worsen 6, 2
- Patient is in a high-risk category with severe symptoms 3, 2
Reporting Requirements
- Foodborne illnesses should be reported to local and state health agencies, though specific requirements vary by jurisdiction 2
- This helps identify outbreaks and prevent further cases 2
Prevention Education
- Most foodborne illnesses can be prevented through proper food handling, storage, and cooking procedures 8
- Education of food handlers and the public is critical in reducing incidence 8
- High-risk individuals (elderly, immunocompromised, pregnant women, young children) should avoid high-risk foods like raw seafood, unpasteurized dairy, and undercooked meats 8, 2