What is the recommended treatment for a 13-year-old patient with bloody diarrhea due to Campylobacter infection?

Treatment of Campylobacter Infection in a 13-Year-Old with Bloody Diarrhea

Azithromycin is the first-line treatment for this 13-year-old patient with bloody diarrhea due to confirmed Campylobacter infection, at a dose of 20-30 mg/kg as a single dose. 1

Rationale for Antimicrobial Therapy

Antimicrobial therapy is indicated in this case because:

• The patient has confirmed Campylobacter infection with bloody diarrhea
• Early treatment (within 72 hours of symptom onset) can significantly reduce symptom duration and prevent complications 1
• Azithromycin has emerged as the preferred first-line therapy due to increasing fluoroquinolone resistance worldwide 1

Treatment Regimen

First-line therapy:

• Azithromycin: 20-30 mg/kg as a single dose 1
  • Alternative regimen: 10 mg/kg/day for 3 days

Alternative options (if azithromycin unavailable or contraindicated):

• Ciprofloxacin: Not recommended as first-line in pediatric patients due to:
  • Increasing fluoroquinolone resistance in Campylobacter worldwide 1
  • Concerns about adverse effects on joints and surrounding tissues in pediatric patients 2

Supportive Care

• Fluid replacement: Reduced osmolarity oral rehydration solution (ORS) is recommended as first-line therapy for mild to moderate dehydration 3
• Nutrition: Continue age-appropriate diet during or immediately after rehydration 3
• Avoid antimotility agents: Antimotility drugs (e.g., loperamide) should not be given to children <18 years with acute diarrhea 3

Monitoring and Follow-up

• Monitor for:
  • Worsening symptoms (increasing fever, bloody stools, severe abdominal pain)
  • Signs of dehydration
  • Response to treatment
• If symptoms persist beyond 14 days, consider non-infectious conditions including inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) 3

Special Considerations

• Antibiotic resistance: Fluoroquinolone-resistant Campylobacter is increasingly prevalent worldwide, making azithromycin the preferred choice 1
• Timing of treatment: Antimicrobial therapy is most beneficial when started early in the illness course (within 72 hours of symptom onset) 1
• Potential complications: Monitor for rare complications such as reactive arthritis 1

Prevention of Transmission

• Emphasize proper hand hygiene after using the toilet and before preparing or eating food 3
• The patient should not return to school until symptoms resolve to prevent transmission 3
• Asymptomatic contacts do not need treatment but should be advised to follow appropriate infection prevention measures 3

Pitfalls to Avoid

• Do not confuse Campylobacter infection with Shiga toxin-producing E. coli infection, as antibiotics may increase the risk of hemolytic uremic syndrome in the latter 1
• Avoid fluoroquinolones as first-line therapy due to increasing resistance rates and concerns about adverse effects in pediatric patients 1, 2
• Do not use antimotility agents in pediatric patients with acute diarrhea 3