Most acute foodborne diarrhoea settles with fluids alone. The exception worth remembering is bloody diarrhoea with little or no fever, especially in a child or after undercooked meat: this pattern raises the possibility of Shiga toxin-producing E. coli. Antibiotics are generally avoided in suspected cases because they may increase the risk of haemolytic uraemic syndrome. Send a stool sample, rehydrate and watch urine output and blood counts.
- Rehydrate first; most foodborne diarrhoea needs no antibiotic.
- Think of Shiga toxin-producing E. coli in bloody diarrhoea with little fever.
- Avoid empirical antibiotics in that pattern while waiting for stool results.
- Check urine output, haemoglobin, platelets and creatinine if symptoms persist.
- Notify suspected outbreaks to the local health authority.
Why it matters
A reflex antibiotic in the wrong case can worsen the outcome.
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