Treatment of Campylobacter Gastroenteritis in Pediatrics
Azithromycin is the first-line antibiotic treatment for Campylobacter gastroenteritis in children, with a recommended dosage of 500 mg once daily for 3 days or a single 1-gram dose, depending on the child's age and weight. 1
Antibiotic Therapy
First-line Treatment
- Azithromycin is preferred due to:
Alternative Options
- Fluoroquinolones (ciprofloxacin, levofloxacin) should be avoided as empiric therapy due to widespread resistance, particularly in Southeast and South Asia (>85% resistance) 1
- Rifaximin should not be used due to high resistance rates and documented treatment failures 1
When to Use Antibiotics
Antibiotics are not necessary for all cases of Campylobacter gastroenteritis. Consider antimicrobial therapy in:
- Severely ill children
- Children with chronic conditions or specific risk factors
- Immunocompromised patients
- Young infants who appear ill
- Cases with systemic symptoms
- Persistent symptoms 1, 3
Rehydration Therapy
Oral Rehydration
- Oral rehydration solution (ORS) is the cornerstone of treatment for mild to moderate dehydration 4, 5
- Avoid "clear liquids" as they can cause osmotic diarrhea and electrolyte imbalance 1
- Continue age-appropriate feeding throughout the diarrheal episode 1, 6
- Breastfeeding should be continued in infants 1
Intravenous Rehydration
Indicated for:
- Severe dehydration
- Shock
- Altered mental status
- Ileus
- Inability to tolerate oral intake due to severe vomiting 1, 5
Supportive Care
Diet Management
- Normal feeding should be continued throughout the illness
- Resume age-appropriate diet during or immediately after rehydration
- Avoiding food during diarrheal episodes can lead to malnutrition, especially in children 1, 6
Medications to Avoid
- Antimotility agents (e.g., loperamide) should not be given to children under 18 years with acute diarrhea 1, 4
- These agents can lead to serious complications in children with inflammatory diarrhea 1
- Antidiarrheal drugs are not recommended as they can interfere with oral therapy and add unnecessarily to the economic cost of illness 4
Monitoring and Follow-up
- Monitor for worsening symptoms and signs of dehydration
- Consider non-infectious conditions if symptoms persist beyond 14 days
- Blood cultures should be obtained from patients with diarrhea and fever, particularly in immunocompromised hosts 1
Prevention Strategies
- Practice 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 1
Common Pitfalls to Avoid
- Using inappropriate fluids like "clear liquids" instead of properly formulated ORS
- Restricting food during diarrheal episodes
- Administering antimotility agents to children
- Overuse of antibiotics in uncomplicated cases, which contributes to bacterial resistance
- Empiric treatment without bacteriological documentation in mild cases 1, 4, 6
By following these evidence-based recommendations, clinicians can effectively manage Campylobacter gastroenteritis in pediatric patients while minimizing complications and promoting recovery.