What is the treatment for food poisoning?

Treatment of Food Poisoning

The cornerstone of food poisoning treatment is supportive care with aggressive rehydration, while antibiotics should be reserved for high-risk patients or severe cases with evidence of invasive bacterial infection. 1, 2, 3

Immediate Management Priorities

Supportive Care (First-Line for All Patients)

• Rehydration is the single most critical intervention for food poisoning management, as most cases are self-limited and resolve with fluid replacement alone 2, 3
• Oral rehydration is preferred when tolerated; intravenous fluids are indicated for patients with clinical dehydration, persistent vomiting, or inability to maintain oral intake 3
• Symptom management includes rest and monitoring for complications 4, 2

When to Contact Emergency Services

• Call emergency medical services immediately for life-threatening symptoms including severe dehydration, altered mental status, or hemodynamic instability 1
• Contact poison control centers for guidance when toxic ingestion is suspected, providing information about the character, timing, and product name of the exposure 1

Antibiotic Therapy: Risk-Stratified Approach

High-Risk Patients Requiring Empiric Antibiotics

Consider empiric antibiotic therapy for patients with: 2, 3

• Advanced age (elderly)
• Immunocompromised status
• Diabetes mellitus
• Liver cirrhosis
• Intestinal hypomotility
• Evidence of invasive disease (bloody diarrhea, high fever, severe systemic symptoms)

When to Withhold Antibiotics

• Do not routinely prescribe antibiotics for uncomplicated food poisoning in otherwise healthy individuals, as most cases are viral or self-limited bacterial infections 4, 3
• Antibiotics are not useful for staphylococcal food poisoning caused by preformed enterotoxins 4

Specific Clinical Scenarios

Staphylococcal Food Poisoning

• Caused by preformed enterotoxins with rapid onset (1-6 hours) 4
• Presents with nausea, vomiting, stomach cramps, and diarrhea 4
• Treatment is purely supportive: rest and fluids; antibiotics are not indicated 4

MRSA Enterocolitis (Antibiotic-Associated)

• Occurs after antibiotic-induced microbial substitution with aggressive diarrhea 4
• Immediately discontinue current antibiotics and initiate oral vancomycin 4

Antidiarrheal Medications: Use with Caution

• Loperamide may be considered for symptomatic relief in adults with non-bloody diarrhea 5
• Avoid antidiarrheals in patients with bloody diarrhea, high fever, or suspected invasive bacterial infection as they may worsen outcomes 5, 3
• Maximum dose: 16 mg daily in adults; use lower doses in pediatric patients based on weight 5

Gastrointestinal Decontamination

Activated Charcoal

• Do not routinely administer activated charcoal for food poisoning 6
• May be considered only when a patient has an intact airway and presents soon after ingestion of a known toxic substance 6
• Should not be administered by lay rescuers without direction from poison control 6

Contraindications

• Never use gastric lavage or activated charcoal for caustic substance ingestions (strong acids or bases) as they may cause additional harm 6
• Do not give anything by mouth unless advised by poison control or emergency medical personnel 1

Diagnostic Approach

• Diagnosis is primarily clinical, based on history (food exposure, timing, symptoms) and physical examination 4, 3
• Stool culture or advanced laboratory testing provides definitive diagnosis but should not delay empiric treatment when foodborne illness is suspected 3
• Common symptoms include vomiting, diarrhea (with or without blood), fever, abdominal cramping, headache, dehydration, myalgia, and arthralgias 7, 3

Prevention and Public Health

• Report foodborne illnesses to local and state health agencies (requirements vary by state) 3
• Education on safe food handling, storage, and cooking is critical for prevention 2, 8
• Immunocompromised patients, elderly, and children are particularly susceptible and require heightened vigilance 2, 8

Key Clinical Pitfalls to Avoid

• Do not withhold fluids or delay rehydration while awaiting diagnostic confirmation 2, 3
• Avoid empiric antibiotics in healthy patients with mild symptoms, as this contributes to resistance without clinical benefit 4, 3
• Do not use ipecac syrup for poisoning treatment 6, 1
• Multiple drug exposures are common; maintain high suspicion for co-ingestions 1