What is the recommended treatment for stool Campylobacter infections?

Treatment of Campylobacter Infections in Stool

Azithromycin is the first-line treatment for Campylobacter infections due to increasing fluoroquinolone resistance worldwide. 1

First-Line Treatment Options

For Mild to Moderate Infections:

• Azithromycin: 500 mg once daily for 3 days 1, 2
  • Preferred first-line therapy due to low resistance rates
  • Particularly effective for Campylobacter jejuni infections
  • Superior to ciprofloxacin in areas with high fluoroquinolone resistance 2

For Severe Infections or Immunocompromised Patients:

• Azithromycin: Consider IV formulation if available
• Hospitalization may be necessary for severe cases with dehydration 1

Alternative Treatment Options

• Ciprofloxacin: 500 mg twice daily for 3-7 days 3
  • Can be used in areas with low fluoroquinolone resistance
  • Caution: Resistance rates up to 19% reported globally 1
  • Particularly high resistance in Southeast Asia and India 1, 2

Treatment Indications

Antimicrobial therapy is indicated for:

1. Patients with severe symptoms (high fever, bloody diarrhea)
2. Immunocompromised hosts
3. Persistent symptoms (>1 week)
4. Dysentery (bloody diarrhea)
5. Systemic spread of infection

Treatment Benefits

• Antimicrobial therapy reduces duration of illness by approximately 1 day 4, 1
• Most beneficial when started early in the illness course 1
• May prevent complications in high-risk patients

Special Considerations

• Avoid antimotility agents if high fever or bloody stools are present 1
• Monitor for worsening symptoms such as increasing fever, severe abdominal pain 1
• Self-limited disease: Many cases resolve without antibiotics within 5-7 days 5
• Relapses can occur in HIV-infected patients after appropriate treatment 4
• Blood cultures should be obtained from patients with diarrhea and fever, particularly in immunocompromised hosts 4

Treatment Pitfalls to Avoid

1. Using fluoroquinolones empirically without considering local resistance patterns
2. Delaying treatment in immunocompromised patients or those with severe disease
3. Confusing with STEC infection: Avoid antibiotics if Shiga toxin-producing E. coli is suspected (bloody diarrhea without fever) as antibiotics may increase risk of hemolytic uremic syndrome 4, 1
4. Inadequate hydration: Ensure proper fluid replacement, especially in severe cases 6

Prevention Strategies

• Proper handwashing after potential contact with feces 4
• Avoid raw or undercooked poultry, meat, and unpasteurized dairy products 4
• Ensure proper cooking temperatures for poultry (internal temperature of 82°C/180°F) 4

Campylobacter infections are often self-limiting in immunocompetent hosts, but early antibiotic therapy can reduce symptom duration and prevent complications in high-risk patients. Given the increasing fluoroquinolone resistance worldwide, azithromycin has emerged as the preferred first-line therapy for Campylobacter infections.