Treatment of Campylobacter Infections
Azithromycin is the first-line treatment for Campylobacter infections due to increasing fluoroquinolone resistance worldwide. 1
First-Line Treatment Options
- Azithromycin:
- Dosing: 1000 mg single dose OR 500 mg daily for 3 days 1
- Preferred for all Campylobacter infections, especially in regions with high fluoroquinolone resistance 1
- Demonstrated superior efficacy against Campylobacter with 96% clinical cure rate compared to 70% with fluoroquinolones in areas with high resistance 1
- Well-tolerated with minimal side effects (primarily mild gastrointestinal complaints in 3% of cases) 1
Alternative Treatment Options
- Fluoroquinolones (e.g., ciprofloxacin, levofloxacin):
- Only recommended in areas with known low fluoroquinolone resistance 1
- Ciprofloxacin: 750 mg single dose OR 500 mg twice daily for 3 days 1
- Levofloxacin: 500 mg single dose OR 500 mg daily for 3 days 1
- Caution: Fluoroquinolone resistance in Campylobacter is widespread (>50% in many regions) 1, 2
- Treatment failures with fluoroquinolones are common in resistant strains, leading to prolonged illness 1, 3
Treatment Considerations
- Early treatment (within 72 hours of symptom onset) is most effective 1
- Antibiotic therapy reduces symptom duration from 50-93 hours to 16-30 hours 1
- Resistance patterns should guide empiric therapy:
- Avoid rifaximin for Campylobacter infections as it has documented treatment failures 1
Special Populations
- Immunocompromised patients should always receive antibiotic treatment even for mild infections due to risk of systemic spread 1, 4
- Severe infections with high fever or dysentery should be treated with azithromycin as first-line therapy 1
- Travelers with diarrhea from regions with high fluoroquinolone resistance (especially Southeast Asia) should receive azithromycin 1
Monitoring and Follow-up
- Most uncomplicated Campylobacter infections resolve within 5-7 days with appropriate treatment 5, 4
- Patients with ciprofloxacin-resistant infections who don't receive appropriate treatment may experience prolonged diarrhea (average 9-12 days vs. 6-7 days) 3
- Microbiologic testing is recommended in returning travelers with severe or persistent symptoms 1
Common Pitfalls
- Using fluoroquinolones empirically without considering local resistance patterns 1
- Delaying treatment beyond 72 hours, which reduces effectiveness 1
- Using rifaximin for suspected Campylobacter, which is ineffective 1
- Continuing fluoroquinolone therapy despite clinical failure, rather than switching to azithromycin 1, 3