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. When considering treatment for Campylobacter jejuni infections, it is essential to assess the severity of illness and the impact on the patient's activities and plans.

• The decision to treat with antibiotics should be based on the severity of symptoms, with azithromycin being the preferred choice 1.
• Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of fluoroquinolone-resistant Campylobacter spp. 1.
• The recommended dosage of azithromycin is a single 1-gm dose or 500 mg daily for 3 days 1.
• Fluoroquinolones, such as ciprofloxacin, may still be effective in areas with low resistance rates, but their use is not recommended as a first-line treatment due to the increasing resistance of Campylobacter spp. 1.
• Antimotility agents like loperamide should be avoided in patients with fever or bloody diarrhea, as they may prolong bacterial shedding and worsen symptoms 1.
• Treatment should begin promptly when indicated, as early intervention can shorten the duration of illness and reduce complications 1.
• It is crucial to consider the potential side effects and interactions of antibiotics, particularly fluoroquinolones, when making treatment decisions 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.