What is the appropriate initial management for a 17-year-old boy with vomiting, diarrhea, and dizziness, suspected of having a Campylobacter infection?

Management of Campylobacter Infection in a 17-Year-Old Patient

The appropriate initial management for this 17-year-old boy with Campylobacter infection is hydration with fluids and electrolytes. 1

Clinical Assessment

The patient presents with:

• Vomiting, diarrhea, and dizziness for 1 day
• History of eating smoked chicken 2 days prior
• Vital signs showing borderline low blood pressure (90/70 mmHg)
• Stool specimen revealing seagull-shaped motile Gram-negative rods (characteristic of Campylobacter)

These findings are consistent with Campylobacter infection, which typically presents with:

• Acute self-limited gastrointestinal illness
• Diarrhea, which may be bloody in 52% of cases
• Fever (present in 59% of cases)
• Abdominal pain/cramping (present in 45% of cases) 1

Management Algorithm

Step 1: Rehydration (First Priority)

• Provide oral rehydration solution (ORS) with WHO-recommended electrolyte concentrations:
  • Sodium 75-90 mEq/L
  • Potassium 20 mEq/L
  • Chloride 65-80 mEq/L
  • Citrate 10 mEq/L
  • Glucose 75-111 mmol/L 2
• Commercial solutions like Pedialyte or generic equivalents are appropriate 1
• For this patient with borderline hypotension and dizziness, administer 2200-4000 mL/day in small, frequent volumes 2

Step 2: Assess for Complications

Determine if this is an "uncomplicated" or "complicated" case:

• Current presentation suggests mild-moderate dehydration with dizziness
• No fever, severe abdominal pain, or bloody stools noted
• No evidence of systemic involvement 1

Step 3: Dietary Management

• Initially restrict to clear liquids
• Resume age-appropriate diet within 4-6 hours of rehydration
• Avoid foods high in simple sugars and fats
• Avoid lactose-containing products, alcohol, and high-osmolar supplements 1, 2

Step 4: Consider Antibiotic Therapy

• For this patient, antibiotics are not indicated initially as:

  • No evidence of severe disease (high fever, bloody diarrhea, severe dehydration)
  • No immunocompromised status
  • Campylobacter enteritis is generally self-limiting 1, 3

• If clinical deterioration occurs or symptoms persist beyond 3-5 days, consider:

  • Azithromycin as first-line therapy (97% susceptibility rate)
  • Avoid fluoroquinolones due to increasing resistance (only 35% susceptibility) 2, 4

Rationale for Management Choice

Hydration with fluids and electrolytes is the most appropriate initial management because:

1. The Clinical Infectious Diseases guidelines clearly state: "The critical initial treatment must include rehydration, which can be accomplished with an oral glucose or starch-containing electrolyte solution in the vast majority of cases." 1

2. The patient shows early signs of dehydration (dizziness, borderline low blood pressure) but is not severely ill, making oral rehydration appropriate 2

3. Antibiotics (options B and C) are not indicated as initial therapy for uncomplicated cases of Campylobacter infection, as:

   • Most cases are self-limiting
   • Antibiotics should be reserved for severe cases with systemic symptoms, bloody diarrhea, or high fever 1, 2, 3
   • Inappropriate antibiotic use contributes to resistance 5, 4

4. Loperamide (option D) is contraindicated in patients under 18 years with acute diarrhea, especially in cases of suspected inflammatory conditions like Campylobacter infection 2

Monitoring and Follow-up

• Monitor hydration status through:

  • Urine output (target ≥0.5 ml/kg/h)
  • Vital signs, especially blood pressure and heart rate
  • Clinical signs of dehydration (skin turgor, mucous membranes) 2

• Consider escalation of care if:

  • Symptoms worsen
  • Unable to maintain hydration orally
  • Development of high fever, bloody diarrhea, or severe abdominal pain 1

The evidence strongly supports that hydration with fluids and electrolytes is the cornerstone of initial management for this patient with Campylobacter infection, with antibiotics reserved only if the clinical condition deteriorates.