What are the treatments for Campylobacter and Yersinia infections?

Treatment for Campylobacter and Yersinia Infections

For Campylobacter infections, azithromycin is the drug of choice, while Yersinia infections should be treated with fluoroquinolones, trimethoprim-sulfamethoxazole, or doxycycline for non-severe cases and a third-generation cephalosporin plus gentamicin for severe cases. 1

Campylobacter Treatment

First-line Treatment

• Azithromycin: 500 mg daily for 3 days or a single 1-gram dose 1
  • Preferred due to increasing fluoroquinolone resistance (up to 19%) in Campylobacter species 1
  • Superior to fluoroquinolones in areas with high resistance rates 2
  • All Campylobacter isolates in studies showed susceptibility to azithromycin, while many were resistant to ciprofloxacin 2

Alternative Treatments (if susceptibility confirmed)

• Fluoroquinolones (e.g., ciprofloxacin) - only if susceptibility is confirmed
• Note: Fluoroquinolone resistance has been reported in up to 50% of Campylobacter isolates in some regions 3

Yersinia Treatment

Non-severe Infections

• Fluoroquinolones (e.g., ciprofloxacin 500 mg twice daily orally) 1, 4
• Trimethoprim-sulfamethoxazole (TMP-SMZ) 1
• Doxycycline 100 mg twice daily 1, 5

Severe Infections

• Third-generation cephalosporin (e.g., ceftriaxone) plus gentamicin 1
  • Recommended for severe disease or bacteremia

Clinical Considerations

When to Treat

• Mild cases: May not require antibiotic treatment 1
• Indications for treatment:
  • Severe illness
  • Immunocompromised patients
  • Prolonged symptoms
  • Dysentery (bloody diarrhea)
  • Systemic symptoms (high fever)

Important Clinical Manifestations

1. Campylobacter:

   • Severe abdominal pain (may mimic appendicitis)
   • Watery, mucoid, or bloody diarrhea
   • Fever
   • Can lead to Guillain-Barré syndrome as a post-infectious complication 1

2. Yersinia:

   • Abdominal pain that may mimic appendicitis
   • Diarrhea
   • Fever
   • Can lead to reactive arthritis 1

Resistance Considerations

• Fluoroquinolone resistance in Campylobacter has increased significantly worldwide 6
• Ciprofloxacin-resistant Campylobacter infections are associated with longer duration of diarrhea (9 vs. 7 days) compared to susceptible strains 7
• Resistance can develop during therapy with fluoroquinolones, leading to treatment failure 3
• Azithromycin remains effective against most Campylobacter strains even in areas with high fluoroquinolone resistance 2

Special Populations

Immunocompromised Patients

• Always treat with antibiotics, even for mild cases 1
• For Campylobacter: Use azithromycin as first-line therapy
• For Yersinia: Consider third-generation cephalosporin plus gentamicin even for non-severe presentations

Travelers

• Azithromycin should be considered first-line for dysentery or fever with diarrhea in travelers, especially from regions with high fluoroquinolone resistance 1

Diagnostic Approach

• Test for these pathogens in stool samples taken within 72 hours of hospital admission 1
• Consider abdominal imaging (ultrasound or X-ray) if clinical deterioration occurs to detect complications such as ileus or toxic megacolon 1

Treatment Pitfalls to Avoid

1. Using fluoroquinolones empirically for suspected Campylobacter without considering local resistance patterns
2. Failing to treat immunocompromised patients with antibiotics
3. Not considering post-infectious complications (Guillain-Barré syndrome, reactive arthritis)
4. Delaying treatment in severe cases, which can lead to bacteremia and other complications