From the Guidelines
The recommended treatment for Campylobacter jejuni infections is azithromycin (500 mg once daily for 3 days) as the preferred first-line treatment due to increasing fluoroquinolone resistance, as supported by the most recent and highest quality study 1.
Key Considerations
- Most mild to moderate infections are self-limiting and resolve within a week with supportive measures including adequate hydration, electrolyte replacement, and rest.
- Antibiotics are recommended for patients with severe symptoms, prolonged illness (more than one week), high fever, bloody diarrhea, pregnancy, immunocompromised status, or systemic spread of infection.
- Alternative options include ciprofloxacin (500 mg twice daily for 5-7 days) in areas with low resistance rates.
- Early antibiotic treatment (within 3 days of symptom onset) is most effective at reducing the duration of illness.
- Antimotility agents like loperamide should be avoided in cases of bloody diarrhea as they may prolong bacterial shedding and increase the risk of complications.
Rationale
- The increasing resistance of Campylobacter jejuni to fluoroquinolones, such as ciprofloxacin, has made azithromycin a more effective treatment option 1.
- Azithromycin has been shown to be effective in reducing the duration of symptoms and improving clinical outcomes in patients with Campylobacter jejuni infections 1.
- The choice of antimicrobial agent may change due to evolving resistance patterns, and azithromycin is currently the preferred treatment option due to its efficacy and safety profile 1.
Important Notes
- Treatment should be initiated promptly in severe cases to prevent complications such as Guillain-Barré syndrome, reactive arthritis, or bacteremia.
- The use of antimicrobial agents should be guided by local resistance patterns and the severity of the infection.
- Further research is needed to monitor the emergence of resistance and to develop new treatment options for Campylobacter jejuni infections.
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 recommended treatment for Campylobacter jejuni infections is ciprofloxacin (PO), when antibacterial therapy is indicated 2.
From the Research
Treatment of Campylobacter jejuni Infections
The recommended treatment for Campylobacter jejuni infections is primarily focused on managing symptoms and, in some cases, using antimicrobial therapy. Key points to consider include:
- The use of antimotility agents is not recommended as they can impede the resolution of the infection 3.
- Antimicrobials such as erythromycin or tetracycline have been shown to shorten the duration of illness in patients with C. jejuni enteritis 3.
- Azithromycin is effective in treating Campylobacter enteritis, especially in areas where ciprofloxacin resistance is prevalent 4.
- Macrolides, including azithromycin and erythromycin, exhibit excellent activity against C. jejuni, with low frequencies of resistance 5.
Antimicrobial Resistance
It's crucial to be aware of the emerging issue of antimicrobial resistance in Campylobacter jejuni:
- The use of antibiotics in animals used for food has accelerated the trend of antimicrobial agent-resistant Campylobacter strains 6.
- Fluoroquinolone resistance in C. jejuni can evolve rapidly in chickens treated with fluoroquinolones, potentially leading to less effective therapy for human campylobacteriosis 7.
- Resistance patterns vary among different antibiotics, with higher resistance rates observed for ofloxacin, moxifloxacin, and tetracycline compared to azithromycin, erythromycin, and amoxicillin-clavulanic acid 5.