What is the treatment for food poisoning?

Treatment of Food Poisoning

The primary treatment for food poisoning is supportive care with rehydration, while avoiding routine use of antibiotics or gastrointestinal decontamination methods unless specifically indicated. 1

Immediate Management Priorities

Supportive Care

• Rehydration is the cornerstone of treatment for food poisoning, as most cases are self-limited and resolve with fluid replacement alone 1
• Oral rehydration is preferred when tolerated; intravenous fluids are reserved for severe dehydration or inability to maintain oral intake 1
• Monitor for signs of dehydration, electrolyte imbalances, and hemodynamic instability 2

When to Contact Emergency Services

• Call emergency medical services immediately if the patient develops life-threatening symptoms including severe dehydration, altered mental status, or hemodynamic instability 2
• Contact poison control centers for guidance when chemical food poisoning is suspected, providing details about the character, timing, and product name of the exposure 2

Gastrointestinal Decontamination

Activated Charcoal

• Do not routinely administer activated charcoal in food poisoning cases 3
• The American Heart Association states there is insufficient evidence to recommend activated charcoal as a routine first aid measure for poisoning 3
• Activated charcoal may be considered only when: the patient has an intact airway, presents soon after ingestion of a known toxic substance, and is under medical supervision 3
• Never administer activated charcoal for caustic substance ingestions (strong acids or bases), as it may cause additional harm 3

Gastric Lavage

• Gastric lavage should not be performed routinely and is only considered in early presentations of specific toxic ingestions under medical supervision 3
• For mushroom poisoning (Amanita phalloides), gastric lavage and activated charcoal via nasogastric tube may be useful only in the early phase when severe gastrointestinal symptoms are present 4, 3

General Decontamination Principles

• Do not give anything by mouth unless advised by poison control or emergency medical personnel 2
• There is insufficient evidence to support dilution with water or milk as a first-aid measure 2
• Ipecac syrup should not be used by the lay public for poisoning treatment 3, 2

Antibiotic Therapy

When to Consider Antibiotics

• Empirical antibiotic therapy should be reserved for high-risk patients only, including elderly, immunocompromised, diabetic, cirrhotic, or those with intestinal hypomotility 1
• Most cases of food poisoning do not require antibiotics and resolve with supportive care alone 1
• Antibiotics are not indicated for routine bacterial food poisoning in otherwise healthy individuals 1

Antidiarrheal Medications

Loperamide Use

• While loperamide is FDA-approved for acute diarrhea, use caution in food poisoning cases as slowing intestinal motility may prolong toxin exposure 5
• For adults with acute diarrhea: initial dose 4 mg followed by 2 mg after each unformed stool, maximum 16 mg daily 5
• Avoid in elderly patients taking QT-prolonging medications 5

Specific Food Poisoning Syndromes

Bacterial Toxin-Mediated (Scombroid, Staphylococcal)

• These can mimic allergic reactions but are caused by bacterial toxins, not immune responses 4
• Treatment remains supportive with rehydration 1
• Antihistamines may provide symptomatic relief for scombroid poisoning 4

Mushroom Poisoning (Amanita phalloides)

• Suspect mushroom poisoning when severe gastrointestinal symptoms (nausea, vomiting, diarrhea, cramping) occur within hours to a day of ingestion 4
• Administer penicillin G intravenously (300,000 to 1 million units/kg/day) despite lack of controlled trial evidence 4
• Consider silibinin/silymarin (30-40 mg/kg/day for 3-4 days), which has shown better outcomes than penicillin G in case reports 4
• List patients for liver transplantation early, as this is often the only lifesaving option 4
• Fluid resuscitation is critical 4

High-Risk Populations

Special Considerations

• Elderly, immunocompromised patients, children, diabetics, and those with liver cirrhosis are at higher risk for severe complications 1
• These patients warrant closer monitoring and earlier consideration of empirical antibiotic therapy 1
• Lower threshold for hospitalization and intravenous fluid administration in high-risk groups 1

Prevention Counseling

• Emphasize food hygiene, proper food storage, and avoiding contaminated food sources 1
• Keep food fresh and prevent contamination during preparation 1