What is the treatment for Campylobacter and Escherichia coli (E. coli) infections?

Treatment for Campylobacter and E. coli Infections

Azithromycin is the first-line treatment for Campylobacter infections due to increasing fluoroquinolone resistance worldwide, while antimicrobial therapy for E. coli infections depends on the specific strain and severity of illness. 1

Treatment for Campylobacter Infections

First-Line Therapy

• Azithromycin:
  • Adults: 500 mg once daily for 3 days or a single 1-gram dose
  • Children: 20-30 mg/kg as a single dose 1
  • Most effective when started within 72 hours of symptom onset
  • All Campylobacter isolates have shown susceptibility to azithromycin in studies 2

Alternative Treatments (in areas with low fluoroquinolone resistance)

• Ciprofloxacin 500 mg twice daily for 3 days 1, 3
• Levofloxacin 500 mg once daily for 3 days 1

Important Considerations

• Fluoroquinolone resistance in Campylobacter is increasing worldwide (>10.2% in Minnesota) 4
• Quinolone resistance can develop during treatment and lead to symptomatic relapse 4
• Antibiotic treatment shortens the duration of illness by approximately 1.32 days 5
• In rare cases of macrolide and fluoroquinolone resistance, fosfomycin-tromethamine may be considered as an alternative 6

Treatment for E. coli Infections

Enterotoxigenic E. coli (ETEC)

• Ciprofloxacin is FDA-approved for infectious diarrhea caused by enterotoxigenic E. coli 3
• Trimethoprim-sulfamethoxazole (TMP-SMZ) is indicated for traveler's diarrhea due to enterotoxigenic E. coli 7

Shiga Toxin-Producing E. coli (STEC)

• Antibiotics should NOT be used for suspected or documented STEC infections 4, 1
• Antimotility agents should also be avoided 4
• Antibiotic treatment may increase the risk of hemolytic uremic syndrome (HUS) 4, 1

General Approach to Treatment

Indications for Antimicrobial Therapy

1. Severe symptoms
2. Immunocompromised hosts
3. Persistent symptoms
4. Dysentery (bloody diarrhea)
5. Systemic spread of infection 1

Supportive Care (First-Line for All Patients)

• Oral rehydration solution (ORS) for mild to moderate dehydration 1
• Continue age-appropriate diet during or immediately after rehydration 1
• IV fluids for severe dehydration

Treatment Algorithm

1. Assess severity: Determine if patient has mild, moderate, or severe illness
2. Identify pathogen if possible: Stool culture to differentiate Campylobacter from E. coli
3. For Campylobacter:
   • Start azithromycin if indicated
   • Monitor for clinical response
4. For E. coli:
   • If ETEC: Consider ciprofloxacin or TMP-SMZ
   • If STEC or suspected STEC: Avoid antibiotics and antimotility agents
   • If other E. coli strains: Treat based on susceptibility testing

Prevention and Follow-up

• Proper hand hygiene after using the toilet and before preparing or eating food 1
• Avoid raw or undercooked poultry, meat, and unpasteurized dairy products 1
• Monitor for worsening symptoms, signs of dehydration, and response to treatment 1
• Consider non-infectious conditions if symptoms persist beyond 14 days 1

Important Caveats

• Antibiotics should not be prescribed simply to reduce secondary transmission 4
• Overuse of antibiotics can lead to emergence of resistant strains 8
• Quinolone resistance in Campylobacter is a growing concern globally 4, 9
• Delayed treatment in immunocompromised patients should be avoided 1