What is the treatment approach for campylobacter (Campylobacter) gastrointestinal (GI) infection?

Treatment of Campylobacter Gastrointestinal Infection

Azithromycin is the drug of choice for treating Campylobacter gastrointestinal infections due to increasing fluoroquinolone resistance. 1

Clinical Presentation

Campylobacter infection typically presents with:

• Watery, mucoid, or bloody diarrhea
• Abdominal pain (often severe and may mimic appendicitis)
• Fever
• Nausea

Treatment Algorithm

Non-severe Cases

• Mild to moderate infection in immunocompetent patients:
  • Consider supportive care only (hydration, electrolyte replacement)
  • Antibiotics may not be necessary as most cases are self-limiting 1, 2

When to Treat with Antibiotics

Antibiotic therapy is indicated for:

• Severe illness (high fever, bloody diarrhea, severe abdominal pain)
• Immunocompromised patients
• Prolonged symptoms (>1 week)
• Pregnancy
• Systemic symptoms

First-line Antibiotic Treatment

• Azithromycin 500mg once daily for 3-5 days 1, 3
  • Preferred due to increasing fluoroquinolone resistance (up to 19% reported) 1
  • Achieves high intracellular concentrations
  • Effective against many fluoroquinolone-resistant strains

Alternative Treatment Options

• Fluoroquinolones (e.g., ciprofloxacin) 4
  • Should only be used if local resistance patterns confirm susceptibility
  • Not recommended in regions with known high fluoroquinolone resistance
  • Ciprofloxacin is FDA-approved for infectious diarrhea caused by Campylobacter jejuni 4

Special Populations

• Immunocompromised patients:

  • Lower threshold for antibiotic treatment
  • May require longer treatment courses to prevent recurrence 1
  • Consider follow-up cultures to confirm clearance if bacteremia present

• Severe disease:

  • Consider hospitalization for IV hydration and antibiotics
  • For patients with severe disease who cannot take oral medications, IV antibiotics may be necessary

Complications to Monitor

1. Post-infectious sequelae:

   • Guillain-Barré syndrome (1 in 1000 infections) 5, 2
   • Reactive arthritis 1, 2
   • Miller Fisher syndrome 2

2. Systemic spread:

   • Bacteremia (more common in immunocompromised patients)
   • Septicemia 1, 6

Prevention Strategies

• Proper handwashing after potential contact with feces, handling pets, gardening 1
• Avoid unprotected sexual practices that might result in oral exposure to feces 1
• Food safety:
  • Avoid raw or undercooked poultry, meat, and seafood
  • Avoid unpasteurized dairy products and fruit juices
  • Avoid raw seed sprouts 1

Key Considerations

• Campylobacter is a leading cause of bacterial gastroenteritis worldwide 2, 7
• Poultry is the primary reservoir and source of human transmission 2, 7
• Increasing antibiotic resistance, particularly to fluoroquinolones, is a significant concern 8, 2
• The CDC has identified antibiotic resistance in Campylobacter as a "significant public health threat" 2
• Stool cultures should be obtained before treatment to guide antibiotic selection when possible
• Relapses can occur after appropriate treatment, particularly in HIV-infected patients 1

By following this treatment approach, clinicians can effectively manage Campylobacter gastrointestinal infections while minimizing the risk of complications and addressing the growing concern of antibiotic resistance.