From the Guidelines
Azithromycin is the recommended antibiotic for the treatment of campylobacter gastroenteritis, particularly in cases of severe disease, immunocompromised patients, or those with prolonged symptoms, due to its efficacy and lower risk of resistance compared to fluoroquinolones 1.
Treatment Approach
The treatment of campylobacter gastroenteritis typically involves supportive care, focusing on maintaining hydration through oral rehydration solutions or, in severe cases, intravenous fluids. Most infections are self-limiting and resolve within 5-7 days without antibiotics. However, antibiotic treatment is recommended for severe cases, immunocompromised patients, pregnant women, or those with prolonged symptoms.
Antibiotic Selection
The choice of antibiotic is crucial in the treatment of campylobacter gastroenteritis.
- Azithromycin 500mg once daily for 3 days is the preferred antibiotic due to its efficacy and lower risk of resistance compared to fluoroquinolones 1.
- Ciprofloxacin 500mg twice daily for 5-7 days is an alternative option, although resistance to fluoroquinolones is increasing 1.
- Erythromycin 500mg four times daily for 5 days is another alternative option, although it may not be as effective as azithromycin or ciprofloxacin 1.
Prevention and Management
Prevention measures include proper food handling, thorough cooking of poultry, and good hand hygiene. Patients should be advised to:
- Stay hydrated and consume easily digestible foods
- Avoid dairy products until recovery
- Avoid anti-diarrheal medications like loperamide, as they may prolong the infection Most patients recover completely, although post-infectious complications like reactive arthritis or Guillain-Barré syndrome can occur rarely 1.
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
Ciprofloxacin is indicated for the treatment of infectious diarrhea caused by Campylobacter jejuni when antibacterial therapy is indicated 2.
From the Research
Treatment Options for Campylobacter Gastroenteritis
- Azithromycin has been shown to be effective in treating Campylobacter enteritis, particularly in areas where ciprofloxacin resistance is prevalent 3
- A study comparing azithromycin and ciprofloxacin found that azithromycin was superior in decreasing the excretion of Campylobacter species and as effective as ciprofloxacin in shortening the duration of illness 3
- Ciprofloxacin, third-generation cephalosporins, azithromycin, ampicillin, cotrimoxazole, and doxycycline are recommended drugs for the treatment of bacterial gastroenteritis, including Campylobacter infections 4
Antibiotic Resistance and Treatment
- The susceptibility pattern of the different bacteria determines the choice of the most appropriate treatment 4
- Azithromycin may be a good empirical therapeutic option for the treatment of bacterial enteritis, including infections caused by Salmonella, Aeromonas, Shigella, and Yersinia species 5
- A randomized, double-blinded, placebo-controlled clinical trial found no significant difference in clinical outcome between azithromycin and placebo in the treatment of Campylobacter concisus diarrhea in adults, although the study was underpowered due to recruitment difficulties 6
Public Health and Prevention
- Campylobacter species are a major cause of food-borne bacterial infectious gastroenteritis worldwide, and poultry meat products are a major source of human infections 7
- A "One World-One Health" approach is required to reduce the burden of campylobacteriosis, including collective efforts to improve hygiene measures, strengthen public health authorities, and educate consumers 7