What is the treatment for Campylobacter (C.) infections?

Treatment of Campylobacter Infections

Azithromycin is the first-line treatment for Campylobacter infections due to high rates of fluoroquinolone resistance worldwide. 1

First-Line Treatment Options

Mild to Moderate Infection

• Azithromycin: 500mg once daily for 5 days 1
  • Preferred due to increasing fluoroquinolone resistance (up to 93% in some regions) 1
  • All Campylobacter isolates in studies were susceptible to azithromycin 2
  • Effective in shortening duration of illness and decreasing pathogen excretion 2

Severe Infection or Bacteremia

• Treatment duration: At least 2 weeks for bacteremia 1
• Consider adding an aminoglycoside (e.g., gentamicin) as a second agent for severe infections 1
• Treatment duration: 14 days for bacteremia is reasonable 1

Alternative Options (Based on Susceptibility)

• Fluoroquinolones (e.g., ciprofloxacin): Only if susceptibility is confirmed 1

  • Resistance rates up to 93% in Asia and 50-80% in many regions 1, 3
  • Treatment failures documented with fluoroquinolone-resistant strains 4, 2

• Tetracyclines (e.g., doxycycline): Consider based on susceptibility testing 3

  • High resistance rates reported in surveillance programs 3

Special Populations

Immunocompromised Patients

• Lower threshold for treatment 1
• Consider longer treatment courses (2-6 weeks) 1
• Addition of a second agent (aminoglycoside) may be prudent 1

HIV-Infected Patients

• For mild disease: Consider withholding therapy unless symptoms persist for several days 1
• For bacteremia: Treat for >2 weeks and consider adding an aminoglycoside 1

Monitoring and Follow-up

• Monitor for clinical response defined by:

  • Improvement in systemic signs and symptoms
  • Resolution of diarrhea 1

• Follow-up stool culture generally not required if clinical response is adequate 1

  • Consider follow-up cultures for:
    • Those who fail to respond clinically
    • Healthcare or food service workers (public health considerations) 1

Treatment Failure Considerations

• If diarrhea persists or recurs after treatment:
  • Consider other enteric infections, particularly C. difficile 1
  • Obtain antimicrobial susceptibility testing to guide therapy 1
  • Consider alternative diagnoses if symptoms persist beyond 14 days 5

Resistance Patterns and Mechanisms

• Fluoroquinolone resistance:

  • Primarily due to mutations in the gyrA gene 4, 6
  • Increased dramatically since the 1990s (from 0% to >80% in some regions) 1, 4
  • Associated with treatment failure 1, 2

• Macrolide resistance:

  • Generally lower than fluoroquinolone resistance (4-15%) 1, 3
  • Increasing in some regions but remains relatively stable 3

Complications and Cautions

• Campylobacter infection has been associated with:

  • Guillain-Barré syndrome 7
  • Reactive arthritis 1

• When using fluoroquinolones, be aware of:

  • QT prolongation risk
  • Peripheral neuropathy risk 8
  • C. difficile-associated diarrhea 8

• When using macrolides, monitor for:

  • Hepatotoxicity
  • QT prolongation
  • C. difficile-associated diarrhea 9

Key Takeaways

1. Azithromycin is preferred over fluoroquinolones due to widespread fluoroquinolone resistance
2. Longer treatment duration (≥2 weeks) is needed for bacteremia or immunocompromised patients
3. Consider adding an aminoglycoside for severe infections or bacteremia
4. Antimicrobial susceptibility testing should guide therapy in treatment failures