From the Guidelines
The drug of choice for Campylobacter jejuni infection is azithromycin, given its efficacy, lower resistance rates, and ability to concentrate in intestinal tissues. For adults, the typical regimen is 500 mg once daily for 3 days, while children should receive 10 mg/kg on day 1 (maximum 500 mg) followed by 5 mg/kg (maximum 250 mg) on days 2-5 1. This recommendation is based on the high level of evidence and strong recommendation for azithromycin as the first-line agent in cases of dysentery, as well as acute watery diarrhea with greater than mild fever, due to the increased likelihood of FQ-resistant Campylobacter and other bacterial causes 1.
Some key points to consider when treating Campylobacter jejuni infection include:
- Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of FQ-resistant Campylobacter spp. 1
- FQ-resistant travel-associated and domestic Campylobacter cases in industrialized countries have been increasingly reported, making azithromycin a preferred choice 1
- Azithromycin is generally well tolerated with minimal side effects, usually dose-related gastrointestinal complaints 1
- Treatment is primarily indicated for severe cases with high fever, bloody diarrhea, worsening symptoms, or in immunocompromised patients 1
- Most healthy individuals with mild infection will recover without antibiotics within a week with supportive care including hydration and electrolyte replacement 1
It's worth noting that while ciprofloxacin 500 mg twice daily for 5-7 days can be used in adults as a second-line option, increasing resistance rates make this a less preferred choice 1. Overall, azithromycin is the preferred treatment for Campylobacter jejuni infection due to its efficacy, safety, and lower resistance rates.
From the FDA Drug Label
Ciprofloxacin Tablets USP, 250 mg, 500 mg and 750 mg is indicated for the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions and patient populations listed below... 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 drug of choice for Campylobacter (C.) jejuni infection is ciprofloxacin 2.
- Key points:
- Ciprofloxacin is indicated for the treatment of infectious diarrhea caused by Campylobacter jejuni.
- The drug is effective against Campylobacter jejuni, as stated in the INDICATIONS AND USAGE section of the package insert.
From the Research
Treatment of Campylobacter jejuni Infection
The drug of choice for Campylobacter jejuni infection is typically a macrolide antibiotic, such as erythromycin or azithromycin 3, 4, 5, 6, 7.
- Erythromycin has been shown to be effective in eradicating C. jejuni from the feces, but it may not alter the natural course of uncomplicated campylobacter enteritis when therapy begins 4 or more days after the onset of symptoms 3.
- Azithromycin is also effective against C. jejuni, with a low frequency of resistance reported in some studies 6, 7.
- The prevalence of macrolide resistance in C. jejuni remains low, but it can be common in C. coli 7.
- Other antibiotics, such as fluoroquinolones and tetracyclines, may also be used to treat Campylobacter infections, but resistance to these antibiotics is more common 4, 5, 6.
Antibiotic Resistance
- Resistance to erythromycin and gentamicin in Campylobacter jejuni remains low 4.
- High levels of resistance to tetracycline and ciprofloxacin are frequently reported by many national surveillance programs 4.
- The mechanisms of resistance to macrolides in Campylobacter include substitutions in the 23S rRNA gene and the presence of erm(B) harbored on multidrug resistance genomic islands 7.