What is the recommended treatment for Campylobacter jejuni infections?

From the Guidelines

Azithromycin is the recommended first-line treatment for Campylobacter jejuni infections, particularly in cases of dysentery or acute watery diarrhea with greater than mild fever, due to its efficacy and the increasing resistance of Campylobacter spp. to fluoroquinolones 1.

Key Considerations

• The decision to treat Campylobacter jejuni infections with antibiotics is based on the severity of illness and the presence of certain risk factors, such as immunocompromised status, pregnancy, or persistent symptoms.
• Azithromycin (500 mg once daily for 3 days) is the preferred treatment option due to its high efficacy and relatively low resistance rates compared to fluoroquinolones 1.
• Fluoroquinolones, such as ciprofloxacin, may still be used in areas with low resistance rates, but their use is generally discouraged due to the increasing prevalence of resistant strains 1.
• Early treatment within 3 days of symptom onset is crucial to reduce illness duration and prevent complications.

Additional Recommendations

• Supportive care with adequate hydration and electrolyte replacement is essential for all patients with Campylobacter jejuni infections.
• Antimotility agents like loperamide should be avoided in patients with fever or bloody diarrhea, as they may prolong bacterial shedding and increase the risk of complications.
• Probiotics may be beneficial in restoring gut flora and reducing symptom duration, although more research is needed to confirm their effectiveness.
• Patients should practice strict hand hygiene to prevent transmission to others and avoid preparing food for others until symptoms resolve.

Outcome-Based Considerations

• The primary goal of treatment is to reduce morbidity, mortality, and improve quality of life for patients with Campylobacter jejuni infections.
• Treatment decisions should be based on the severity of illness, presence of risk factors, and the likelihood of antibiotic resistance 1.
• Azithromycin is generally well-tolerated, with minimal side effects, making it a suitable option for most patients 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 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 preventing complications.

• Antibiotics such as erythromycin or tetracycline have been shown to shorten the duration of illness 3.
• However, the emergence of multidrug resistance in Campylobacter jejuni isolates is a concern, particularly in patients with human immunodeficiency virus 4.
• Azithromycin has been found to be effective in treating Campylobacter enteritis, especially in areas where ciprofloxacin resistance is prevalent 5.
• Other therapeutic approaches, such as reducing C. jejuni colonization in chicken farms using vaccination, bacteriocins, and phage therapy protocols, are being explored 6.
• Macrolides, including azithromycin and erythromycin, have shown excellent activity against C. jejuni, with low frequencies of resistance 7.

Antibiotic Resistance and Treatment Options

• The increasing resistance of Campylobacter jejuni to antibiotics such as tetracycline, doxycycline, erythromycin, and fluoroquinolones is a concern 4.
• Azithromycin and other macrolides may be effective alternatives to ciprofloxacin in areas where resistance is prevalent 5.
• The use of amoxicillin-clavulanic acid and other antibiotics may also be considered, depending on the susceptibility of the C. jejuni isolate 7.

Prevention and Control Measures

• Preventing the spread of Campylobacter jejuni through proper handling and cooking of food, as well as good hygiene practices, is crucial in reducing the incidence of infections 6.
• Reducing C. jejuni colonization in chicken farms and implementing high hygiene standards during poultry meat processing can also help prevent infections 6.