What are the recommended antibiotics for treating campylobacter infections?

From the Guidelines

Azithromycin is the recommended first-line antibiotic for treating campylobacter infections, particularly in cases of dysentery or when fluoroquinolone-resistant Campylobacter is suspected. The choice of antibiotic should be based on the severity of the illness, the likelihood of treatment efficacy, and regional patterns of antimicrobial resistance 1.

Key Considerations

• Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of fluoroquinolone-resistant Campylobacter 1.
• Fluoroquinolones, such as ciprofloxacin, may be used as an alternative, but increasing resistance is a concern 1.
• Rifaximin is not recommended for the treatment of campylobacter infections due to high levels of resistance and clinical evidence of treatment failure 1.

Treatment Recommendations

• Azithromycin (500 mg daily for 3 days) is the recommended first-line treatment for campylobacter infections 1.
• Fluoroquinolones, such as ciprofloxacin (500 mg twice daily for 5-7 days), may be used as an alternative, but with caution due to increasing resistance 1.
• Treatment is typically recommended for patients with severe symptoms, prolonged illness, immunocompromised status, or pregnancy 1.
• Most healthy individuals with mild campylobacter enteritis will recover without antibiotics in about a week with supportive care, including hydration and electrolyte replacement 1.

Important Notes

• Antibiotic treatment, when indicated, can shorten the duration of symptoms and reduce bacterial shedding, which helps prevent transmission to others 1.
• It is essential to complete the full course of antibiotics even if symptoms improve before finishing the prescribed regimen 1.
• Antimotility agents should generally be avoided as they can prolong bacterial carriage and potentially worsen the infection 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 recommended for the treatment of campylobacter infections, specifically Campylobacter jejuni, when antibacterial therapy is indicated 2.

From the Research

Recommended Antibiotics for Campylobacter Infections

The following antibiotics are recommended for treating campylobacter infections:

• Azithromycin: effective in decreasing the excretion of Campylobacter species and shortening the duration of illness 3
• Erythromycin: an alternative to azithromycin, but with lower efficacy 4
• Ciprofloxacin: effective, but resistance is prevalent in some areas 3, 5, 6
• Tetracycline: may be used, but resistance has been detected in some isolates 5, 6

Antibiotic Resistance Profiles

Antibiotic resistance profiles of Campylobacter species vary by region and country:

• High prevalence of resistance to ciprofloxacin, erythromycin, and tetracycline has been detected in some regions 5, 6
• Azithromycin resistance has also been detected, including heteroresistance in some isolates 7, 5
• Gentamicin and chloramphenicol may be effective alternatives, but their use is limited due to potential side effects and resistance 6

Treatment Considerations

Treatment of campylobacter infections should be guided by antibiotic susceptibility testing and local resistance profiles:

• Azithromycin is a recommended first-line treatment, but its efficacy may be compromised in areas with high resistance rates 3, 7
• Combination therapy or alternative antibiotics may be necessary in cases of treatment failure or suspected resistance 5, 6