Treatment of Campylobacter Diarrhea
Azithromycin is the first-line treatment for Campylobacter infections, with a recommended dose of 500 mg once daily for 3 days or a single 1-gram dose for adults, started within 72 hours of symptom onset. 1
Antimicrobial Therapy Approach
First-Line Treatment
- Azithromycin:
- Adults: 500 mg once daily for 3 days or a single 1-gram dose
- Children: 20-30 mg/kg as a single dose
- Most effective when started within 72 hours of symptom onset 1
Alternative Treatments
- Ciprofloxacin: 500 mg twice daily for 3 days (in areas with low resistance) 1, 2
- Levofloxacin: 500 mg once daily for 3 days (in areas with low resistance) 1, 3
When to Use Antimicrobial Therapy
Antimicrobial treatment is indicated for:
- Patients with severe symptoms
- Immunocompromised patients
- Patients with persistent symptoms
- Patients with bloody diarrhea (dysentery)
- Cases with systemic spread of infection 4, 1
Supportive Care
Rehydration
- Oral rehydration solution (ORS) for mild to moderate dehydration
- Intravenous fluids (isotonic solutions like lactated Ringer's or normal saline) for:
- Severe dehydration
- Shock
- Altered mental status
- Failure of oral rehydration therapy
- Ileus 1
Nutrition
- Continue normal feeding throughout the diarrheal episode
- Resume age-appropriate diet during or immediately after rehydration
- No evidence supports dietary restrictions during infectious diarrhea 1
Antimotility Agents
- Not recommended for children under 18 years with acute diarrhea
- May be considered in immunocompetent adults with acute watery diarrhea after bacterial pathogens have been ruled out
- Loperamide in combination with appropriate antibiotic treatment can help reduce gastrointestinal symptoms and duration of illness 1, 3
Special Considerations
Treatment Benefits and Timing
- Antimicrobial therapy is most beneficial when started early in the illness course
- Treatment reduces duration of illness by approximately 1 day 4, 1
- Without treatment, most cases are self-limited and resolve within 5 days 3
Antimicrobial Resistance
- Increasing fluoroquinolone resistance, particularly among Campylobacter species, makes azithromycin the preferred first-line agent 1, 3
- Ciprofloxacin and levofloxacin are becoming less effective due to resistance 3
Preventive Measures
- Proper hand hygiene after using the toilet and before preparing or eating food
- Avoid raw or undercooked poultry, meat, and unpasteurized dairy products
- Asymptomatic contacts should follow appropriate infection prevention measures but do not require preventive therapy 1
Common Pitfalls to Avoid
- Overusing antibiotics in uncomplicated cases, which contributes to bacterial resistance
- Using inappropriate fluids instead of properly formulated ORS
- Restricting food during diarrheal episodes, which can lead to malnutrition
- Administering antimotility agents to children or in cases of inflammatory diarrhea 1
Monitoring
- Watch for worsening symptoms and signs of dehydration
- Consider non-infectious conditions if symptoms persist beyond 14 days
- Obtain blood cultures from patients with diarrhea and fever, particularly in immunocompromised hosts 1