What is the treatment for Campylobacter (campylobacter) diarrhea?

From the Guidelines

Azithromycin is the recommended first-line treatment for Campylobacter diarrhea, particularly for severe cases or those with high fever, due to its efficacy and the increasing resistance of Campylobacter to fluoroquinolones like ciprofloxacin. The treatment for Campylobacter diarrhea typically involves supportive care and sometimes antibiotics. Most cases are self-limiting and resolve within a week with adequate hydration and electrolyte replacement. Patients should drink plenty of fluids to prevent dehydration and may use over-the-counter medications like loperamide (Imodium) for symptom relief, though these should be avoided if there's fever or bloody diarrhea. For severe cases, antibiotic treatment with azithromycin (500 mg daily for 3 days or a single 1-gm dose) may be prescribed, as it has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of FQ-resistant Campylobacter spp. 1.

Key considerations in the selection of an empiric antibiotic include the likelihood of treatment efficacy and rapidity of response, regional patterns of probable target pathogens and their antimicrobial resistance, safety and tolerance profile of the antibiotic, simplicity of treatment regimen, and cost 1. Azithromycin has demonstrated effective and comparable cure rates with shigellosis, another common agent causing dysentery, and is generally well tolerated with minimal side effects, usually dose-related gastrointestinal complaints 1.

During recovery, patients should follow a bland diet, avoid dairy products temporarily, and practice good hygiene to prevent spreading the infection to others. It's also important to note that some Campylobacter strains have developed resistance to fluoroquinolones like ciprofloxacin, making azithromycin a preferred choice 1. Early antibiotic treatment can shorten the duration of symptoms and reduce bacterial shedding, particularly in patients with high fever, bloody diarrhea, severe symptoms, prolonged illness, pregnancy, or immunocompromised status.

Some key points to consider when treating Campylobacter diarrhea include:

• The importance of assessing the severity of illness and the effects it will have on the patient’s activities and plans
• The need to consider the syndromes separately, as their antibiotic management may differ
• The potential for drug interactions and the possible potentiating effects of antimicrobials, particularly FQs, on the acquisition of travel-associated gut dysbiosis and MDR bacteria 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.

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

• Key points:
  • Ciprofloxacin is effective against Campylobacter jejuni.
  • Antibacterial therapy should only be used when indicated.
  • Culture and susceptibility tests should be performed before treatment to determine the susceptibility of the organism to ciprofloxacin.

From the Research

Treatment for Campylobacter Diarrhea

The treatment for Campylobacter diarrhea typically involves antibiotic therapy. Some key points to consider include:

• Azithromycin is often recommended as the first-line antibiotic for the treatment of acute watery diarrhea, including Campylobacter infections 3, 4, 5.
• The dosage of azithromycin can vary, but a single dose of 500 mg or 1,000 mg is commonly used 3, 4.
• Other antibiotics, such as levofloxacin and ciprofloxacin, may also be effective, but their use is becoming less common due to increasing resistance among Campylobacter spp. 3, 4.
• Rifaximin is another alternative for acute watery diarrhea, but it should not be used in cases of invasive illness 3.
• Loperamide can be used in combination with antibiotic treatment to further reduce gastrointestinal symptoms and duration of illness 3.

Antibiotic Resistance and Treatment Efficacy

Some studies have investigated the efficacy of different antibiotics in treating Campylobacter infections, including:

• A study comparing azithromycin and ciprofloxacin for the treatment of Campylobacter enteritis in travelers to Thailand found that azithromycin was superior to ciprofloxacin in decreasing the excretion of Campylobacter species 4.
• A randomized, double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen for the treatment of traveler's diarrhea in Thailand found that single-dose azithromycin was the most effective treatment 5.
• A study evaluating the efficacy of azithromycin versus placebo for the treatment of Campylobacter concisus diarrhea in adults found no significant difference in clinical outcome between the two groups, but the study was limited by a small sample size 6.

Antimicrobial Susceptibility and Virulence Surveillance

Surveillance studies have investigated the antimicrobial susceptibility and virulence of Campylobacter spp. isolated from patients, including:

• A study in Taiwan found that the antimicrobial sensitivity rates for erythromycin, ciprofloxacin, and tetracycline were 80.4%, 5.4%, and 3.4%, respectively, and recommended erythromycin as the first choice of treatment for campylobacteriosis 7.