Treatment of Mild Food Poisoning
Oral rehydration with reduced osmolarity oral rehydration solution (ORS) is the cornerstone of treatment for mild food poisoning, combined with early resumption of a normal diet once rehydration begins. 1, 2
Immediate Management: Rehydration
Oral rehydration therapy is first-line treatment for mild food poisoning presenting with diarrhea and/or vomiting. 1, 2
- Use reduced osmolarity ORS rather than plain water, sports drinks, or juice, as it optimally replaces fluid and electrolyte losses. 1, 2
- For adults: Drink ORS frequently in small amounts until clinical dehydration is corrected. 1
- If vomiting is present: Give small, frequent volumes (5-10 mL) every 1-2 minutes, gradually increasing as tolerated. 2
- Continue ORS until diarrhea and vomiting resolve, replacing ongoing stool losses. 1
The WHO-recommended ORS can be purchased at pharmacies (Pedialyte, Ceralyte) or prepared by mixing 3.5 g NaCl, 2.5 g NaHCO3, 1.5 g KCl, and 20 g glucose per liter of clean water. 1
Dietary Management
Resume normal eating during or immediately after rehydration is complete—do not withhold food. 1, 2
- Early refeeding shortens illness duration and improves outcomes compared to prolonged fasting. 2
- There is no need for a "bland diet" or BRAT diet in mild cases. 1
- If breastfeeding, continue throughout the illness. 1
What NOT to Do
Avoid antimotility agents (loperamide, Imodium) in mild food poisoning, especially if any of the following are present: 1, 2
- Fever
- Bloody diarrhea
- Severe abdominal pain
- Signs suggesting inflammatory diarrhea
While loperamide may be used in immunocompetent adults with watery diarrhea once adequately hydrated, it should never be given to children under 18 years. 1
Do not administer activated charcoal, ipecac, or induce vomiting—these are not beneficial and may cause harm. 1
Do not give milk or water to "dilute the poison" unless specifically advised by poison control, as there is no evidence of benefit and it may cause aspiration. 1
When Antibiotics Are NOT Needed
Most mild food poisoning does not require antibiotics, as the majority of cases are self-limited and resolve with supportive care alone. 1, 3
- Antibiotics are not useful for toxin-mediated food poisoning (e.g., Staphylococcus aureus enterotoxin). 4
- Empirical antibiotics should be reserved for high-risk patients or severe presentations. 3
Red Flags Requiring Medical Evaluation
Seek medical attention if any of the following develop: 2
- Bloody diarrhea (may indicate invasive bacterial infection requiring antibiotics or STEC O157 requiring avoidance of antibiotics) 1
- Signs of severe dehydration (postural dizziness, reduced urination, altered mental status) 1
- High fever (>38.5°C/101.3°F) 1
- Severe or worsening abdominal pain 1
- Symptoms lasting >3 days without improvement 1
- Inability to tolerate oral fluids 2
Special Populations
Immunocompromised patients, elderly, and those with chronic diseases (diabetes, cirrhosis) are at higher risk for complications and may require earlier medical evaluation and consideration of empirical antibiotics. 3
Key Pitfall to Avoid
The most common error is inadequate rehydration while focusing on stopping diarrhea with antimotility agents. Rehydration is always the priority—diarrhea is the body's mechanism to clear the pathogen or toxin. 1, 2