What is the treatment for Campylobacter jejuni diarrhea?

From the Guidelines

The treatment for Campylobacter jejuni diarrhea should be azithromycin (500 mg once daily for 3 days) due to its low resistance rates and effectiveness in reducing symptom duration and bacterial shedding. This recommendation is based on the most recent and highest quality study available, which suggests that azithromycin is the preferred antibiotic for the treatment of Campylobacter jejuni diarrhea, especially in cases of severe illness or high fever 1.

Key Considerations

• The decision to treat Campylobacter jejuni diarrhea with antibiotics should be based on the severity of illness and the presence of high fever, bloody diarrhea, or worsening symptoms.
• Azithromycin is generally well tolerated with minimal side effects, making it a suitable option for most patients.
• Ciprofloxacin (500 mg twice daily for 3-5 days) can be used as an alternative, although resistance rates are increasing, particularly in Southeast Asia and other regions 1.
• Antimotility agents like loperamide should be avoided in severe cases, as they may prolong bacterial presence in the intestine.
• Probiotics may help restore gut flora and can be considered as an adjunctive therapy.

Treatment Approach

• For mild to moderate cases, oral rehydration with fluids containing electrolytes is sufficient.
• For severe cases or patients with high fever, bloody diarrhea, or worsening symptoms, antibiotic therapy with azithromycin is recommended.
• Patients should maintain good hygiene practices to prevent transmission to others, as the bacteria can be shed in stool for several weeks after symptoms resolve.

Resistance Patterns

• Fluoroquinolone resistance among Campylobacter spp. has increased significantly over the past decade, with high resistance rates reported in many regions, including Southeast Asia and South America 1.
• Azithromycin resistance rates are relatively low, making it a preferred option for the treatment of Campylobacter jejuni diarrhea.

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.

The treatment for Campylobacter jejuni diarrhea is ciprofloxacin (PO) when antibacterial therapy is indicated 2.

From the Research

Treatment Options for Campylobacter jejuni Diarrhea

• The treatment for Campylobacter jejuni diarrhea typically involves antimicrobial therapy, with the goal of shortening the duration of illness and reducing the risk of complications 3, 4, 5.
• Azithromycin has been shown to be effective in treating Campylobacter enteritis, particularly in areas where ciprofloxacin resistance is prevalent 4.
• Erythromycin and tetracycline have also been used to treat C. jejuni enteritis, with studies suggesting that they can shorten the duration of illness 5.
• However, the use of antimotility agents is not recommended, as they may impede the resolution of the infection 5.
• In some cases, oral fluid and electrolyte replacement may be necessary to manage severe dehydration and profuse diarrhea 6.

Antibiotic Resistance

• The emergence of multidrug resistance in C. jejuni is a concern, as it can limit treatment options 3.
• The use of antibiotics such as ciprofloxacin and erythromycin can select for resistant strains, highlighting the need for prudent use of antimicrobial therapy 3, 4.

Clinical Trials

• 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 7.
• However, the study was limited by recruitment difficulties and did not reach its estimated sample size, which may have affected the results 7.