What is the recommended management for campylobacter infection?

Management of Campylobacter Infection

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

Clinical Presentation and Diagnosis

• Most common symptoms:
  • Watery or bloody diarrhea (90% of cases may have bloody diarrhea) 2
  • Fever (47% of cases) 2
  • Abdominal pain (29% of cases) - can be severe and mimic appendicitis 3, 2
  • Vomiting (22% of cases) 2
• Diagnosis:
  • Stool cultures should be obtained within 72 hours of hospital admission for symptomatic patients 3
  • Blood cultures should be obtained from patients with diarrhea and fever, particularly in immunocompromised hosts 1

Treatment Algorithm

1. Mild Campylobacter Infection

• Most cases are self-limiting in immunocompetent hosts 1, 4
• Supportive care is recommended:
  • Adequate hydration and electrolyte replacement 1
  • Loperamide or bismuth subsalicylate may be considered for symptom relief 3
• Antibiotics are not recommended for mild disease 3, 1

2. Moderate to Severe Infection

• Indications for antibiotic therapy:

  • Severe symptoms
  • Immunocompromised hosts
  • Persistent symptoms (>1 week)
  • Dysentery (bloody diarrhea)
  • Systemic spread of infection 1

• First-line antibiotic therapy:

  • Azithromycin 500 mg once daily for 3 days 1

• Alternative therapy (if local resistance patterns permit):

  • Ciprofloxacin 500 mg twice daily for 3-7 days 1, 5
  • Note: Fluoroquinolones should be used cautiously due to high resistance rates (70-80% in Southeast Asia and India) 3, 1

3. Special Populations

• Immunocompromised patients:

  • Early antibiotic treatment is recommended to reduce symptom duration and prevent complications 1
  • Systemic treatment should be provided 3
  • Monitor for relapses, particularly in HIV-infected patients 1

• Cancer patients:

  • Systemic antibiotic treatment is recommended 3
  • Consider azithromycin as first-line therapy due to fluoroquinolone resistance 3, 1

Complications and Follow-up

• Potential complications:

  • Guillain-Barré syndrome (approximately 1 in 1000 infections) 4, 6
  • Reactive arthritis 3, 6
  • Bacteremia and septicemia (rare, more common in immunocompromised hosts) 1, 6

• Warning signs requiring immediate attention:

  • Increasing fever
  • Worsening bloody stools
  • Severe abdominal pain
  • Signs of dehydration
  • Neurological symptoms 1

Prevention

• Proper handwashing after potential contact with feces 1
• Avoiding raw or undercooked poultry, meat, and unpasteurized dairy products 1
• Ensuring proper cooking temperatures for poultry 1, 7

Important Clinical Considerations

• Antimicrobial therapy is most beneficial when started early in the illness course 1
• Do not confuse with Shiga toxin-producing E. coli infection, as antibiotics may increase risk of hemolytic uremic syndrome in the latter 1
• Rifaximin is not effective against Campylobacter species, which are resistant to this antibiotic 3
• Fatal Campylobacter infections are rare but more common in severely immunocompromised hosts 1