From the Guidelines
The recommended treatment for this 5-year-old boy with Campylobacter coli infection is azithromycin, as it is the preferred antibiotic for treating Campylobacter infections, especially in children, due to its efficacy and safety profile 1. The appropriate dosage would be 10 mg/kg on the first day, followed by 5 mg/kg for the next 4-6 days. Since the child is still symptomatic with continued diarrhea despite resolution of fever, antibiotic treatment is warranted to shorten the duration of illness and reduce the risk of complications. While Campylobacter infections can often be self-limiting, this child's persistent symptoms after four days indicate the need for intervention. Ampicillin, although sensitive, is not the first choice due to the potential for resistance and the availability of better alternatives like azithromycin. Tetracycline is also sensitive but is contraindicated in children under 8 years due to the risk of dental staining and enamel hypoplasia. Ciprofloxacin cannot be used due to resistance, and erythromycin shows only intermediate sensitivity. In addition to antibiotics, continued oral rehydration is important to prevent dehydration. Parents should be advised that improvement should occur within 2-3 days of starting antibiotics, but to return for evaluation if symptoms worsen or if the child develops signs of dehydration such as decreased urination, dry mouth, or lethargy. It's worth noting that the most recent guidelines recommend azithromycin as the first-line treatment for Campylobacter infections, especially in cases of dysentery or severe diarrhea 1. The use of azithromycin has been shown to be effective in reducing symptom duration and is generally well-tolerated with minimal side effects 1.
From the Research
Treatment Options for Campylobacter coli Infection
The patient's stool culture shows a large growth of Campylobacter coli, which is resistant to Ciprofloxacin, sensitive to Ampicillin, and has intermediate susceptibility to Erythromycin and sensitivity to Tetracycline. Considering these results, the treatment options can be evaluated as follows:
- Ampicillin is a possible treatment option, given its sensitivity to Campylobacter coli 2. However, it is essential to consider the potential for antibiotic hypersensitivity and adverse reactions, which can limit treatment options and contribute to resistance 3.
- Tetracycline is another possible treatment option, given its sensitivity to Campylobacter coli. Oral tetracyclines have been used to treat various infections, including community-acquired pneumonia, and may be considered for adult outpatients with CAP 4.
- The activity of other antibiotics, such as ertapenem, ciprofloxacin, ceftriaxone, piperacillin-tazobactam, and ampicillin-sulbactam, against common clinical isolates of community-acquired bacteremia has been studied 5. However, the effectiveness of these antibiotics against Campylobacter coli specifically may vary.
- The distinction between bactericidal and bacteriostatic antibiotics may not be clinically relevant for patients with serious bacterial infections, including those caused by Campylobacter coli 6.
Considerations for Antibiotic Treatment
When selecting an antibiotic treatment, it is crucial to consider the following factors:
- Antibiotic susceptibility patterns, as shown in the patient's stool culture results
- Potential for antibiotic hypersensitivity and adverse reactions 3
- Effectiveness of the antibiotic against the specific infection, in this case, Campylobacter coli
- Potential for resistance development and the need for alternative treatment options 5