Pediatric Food Poisoning Treatment & Management

The mainstay of medical treatment in food poisoning is fluid and electrolyte replenishment. Guidelines for the diagnosis and management of food-borne illnesses have been established by the American Medical Association, American Nurses Association-American Nurses Foundation, the Centers for Disease Control and Prevention, Center for Food Safety and Applied Nutrition, the US Food and Drug Administration (FDA), Food Safety and Inspection Service, and US Department of Agriculture.^[6] Most food-borne diseases (FBDs) are not amenable to specific antidotes or antimicrobial therapy, but the few exceptions are mentioned below.

• Short incubation

  • Chemical/mushroom: Treatment varies depending on the chemical or toxin. Consult with staff at a poison control center or an emergency manual. For most agents, the care is supportive only. Exceptions include intravenous mannitol for ciguatera toxin, antihistamines for scombroid poisoning, and atropine or physostigmine for poisoning with certain mushrooms.
  • Bacterial: No specific therapy is indicated. Institute rehydration.
• Intermediate incubation

  • Campylobacter infections: A macrolide, especially erythromycin, and possibly azithromycin, a quinolone, or a parenteral aminoglycoside (eg, gentamicin) are indicated. However, symptoms often resolve by the time culture results are received.
  • Shigella infection: Antibiotic treatment of infection is currently problematic because of increasing rates of resistance.^[7] Treatment is important to prevent transmission. Azithromycin, third-generation cephalosporins (including oral cefixime or cefpodoxime), and ciprofloxacin are choices based on laboratory susceptibility testing. Consultation with a pediatric infectious diseases specialist is highly recommended.
  • Salmonella infection: Institute rehydration. Administer parenteral extended-spectrum cephalosporin if bacteremia occurs.
  • Salmonella enteric fever: A typical regimen is a parenteral cephalosporin followed by oral amoxicillin, quinolone or cefixime based on susceptibility.
  • V cholerae, V parahaemolyticus, Vibrio vulnificus: Institute rehydration; a tetracycline can be administered to children older than 8 years.
  • Enterotoxigenic E coli (ETEC): For rapid resolution of illness, a short course of a quinolone, trimethoprim-sulfamethoxazole (TMP-SMZ), azithromycin, or rifaximin can be administered on an outpatient basis.
  • Norwalklike virus, rotavirus, or other viruses acquired via the fecal-oral route: Supportive care is indicated. Rehydration is especially important for infants with rotavirus infection.
  • Botulism: Treatment is chiefly supportive, with the notable exception of infant botulism, for which an antitoxin (BabyBIG) is available from the California Department of Health Services. Contact them at (510) 231-7600 to review the indications for such treatment. Rarely, use of a botulinum antitoxin can be considered in older children by contacting the CDC at 800-CDC-INFO.
• Long incubation

  • Enterohemorrhagic E coli (EHEC): Most studies suggest that antibiotics are likely to increase the risk of developing hemolytic-uremic syndrome (HUS). Treatment, including treatment of HUS, is supportive.
  • Yersinia enterocolitica infection: Treatment is supportive. Parenteral aminoglycosides or third-generation cephalosporins are indicated if bacteremia is present.
• Very long incubation

  • Giardiasis: Metronidazole is the drug of choice, but tinidazole and nitazoxanide may be better tolerated.
  • Amebiasis: Metronidazole followed by an luminal agent, usually tinidazole or paromomycin, is indicated.
  • Cryptosporidiosis: The illness is brief and self-limiting. Nitazoxanide or paromomycin are considered in severe cases.
  • Cyclosporiasis: TMP-SMZ may be an effective treatment for the immunocompromised host.
  • Listeria Infection: Intravenous ampicillin or TMP-SMZ is administered to treat systemic Listeria infection.
  • Brucellosis: A combination of doxycycline and streptomycin is the regimen of first choice.

• Consultation with an infectious disease specialist may be beneficial in complicated or unusual cases.
• For chemical or mushroom poisonings, consult with a poison control center for advice on specific antidotes and for help with identifying the implicated mushrooms.
• For suspected point-source outbreaks of staphylococcal toxins or infective pathogens, call the local health department. Staff members usually have information regarding the species or strain involved and its antibiotic susceptibility.

• As with other pediatric gastroenteritides, dietary restrictions are no longer are the standard of care, and the child is allowed solid foods as desired to maintain nutritional status.