From the Guidelines
Azithromycin is the recommended first-line treatment for Campylobacter jejuni infection, particularly in cases of dysentery or severe illness, due to its efficacy and the increasing resistance of Campylobacter spp. to fluoroquinolones 1. The treatment for Campylobacter jejuni infection typically involves supportive care and antibiotics in certain cases. For mild infections, supportive measures including adequate hydration, electrolyte replacement, and rest are often sufficient as the infection is usually self-limiting and resolves within a week.
Key Considerations
- For more severe cases or in high-risk patients (immunocompromised, pregnant women, elderly), antibiotic therapy is recommended.
- The preferred antibiotic is azithromycin 500mg once daily for 3 days, or alternatively, a single 1-gm dose, due to its superior efficacy compared to levofloxacin in achieving clinical cure, especially in areas with high rates of fluoroquinolone-resistant Campylobacter spp. 1.
- Treatment should begin early, ideally within 3 days of symptom onset, for maximum effectiveness.
- During treatment, patients should avoid anti-diarrheal medications like loperamide as they can prolong bacterial shedding.
- Probiotics may help restore gut flora.
- Antibiotics work by inhibiting bacterial protein synthesis or DNA replication, preventing bacterial growth and allowing the immune system to clear the infection.
- Proper food handling and hygiene practices are essential to prevent reinfection or transmission to others.
Additional Considerations
- Fluoroquinolones, such as ciprofloxacin, may still be effective in some cases, but their use is limited by the increasing resistance of Campylobacter spp. 1.
- Rifaximin, a nonabsorbable antibiotic, has demonstrated comparable efficacy to fluoroquinolones in non-invasive traveler's diarrhea, but its effectiveness against Campylobacter jejuni is limited 1.
- The choice of antibiotic should be guided by the severity of illness, the likelihood of treatment efficacy, and the regional patterns of antimicrobial resistance 1.
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
The treatment for Campylobacter (C.) jejuni infection is ciprofloxacin (PO), as it is indicated for the treatment of infectious diarrhea caused by this microorganism 2.
From the Research
Treatment Options for Campylobacter jejuni Infection
- The treatment for Campylobacter jejuni infection is typically decided on clinical grounds, as most cases are self-limiting 3.
- Erythromycin is often considered the drug of choice for treating C. jejuni infections 3, 4.
- However, resistance to erythromycin and other antibiotics, such as ciprofloxacin, has been reported 5, 4.
- Azithromycin has been shown to be effective in treating Campylobacter enteritis, particularly in areas where ciprofloxacin resistance is prevalent 6.
- Rifaximin has been investigated as a potential prophylactic treatment, but it has been found to be ineffective in preventing campylobacteriosis in a controlled human infection model 7.
Antibiotic Resistance
- Resistance to ciprofloxacin is more common than resistance to erythromycin, with 23% of C. jejuni isolates found to be resistant to ciprofloxacin in one study 4.
- The emergence of multidrug resistance in C. jejuni is a concern, particularly in immunocompromised patients 5.
- The use of azithromycin may be an effective alternative to ciprofloxacin in areas where ciprofloxacin-resistant Campylobacter species are prevalent 6.
Treatment Considerations
- Treatment with antibiotics may be indicated in severe or complicated cases of C. jejuni infection, or in immunocompromised patients 3, 4.
- The choice of antibiotic should be based on the susceptibility of the C. jejuni isolate, as well as the clinical presentation and medical history of the patient 4, 6.