What is the treatment for Campylobacter jejuni infection?

Treatment of Campylobacter jejuni Infection

Azithromycin is the preferred first-line treatment for Campylobacter jejuni infections, with a recommended dosing regimen of either 1000 mg as a single dose or 500 mg daily for 3 days. 1

First-Line Treatment

• Azithromycin is recommended by the Infectious Diseases Society of America as the first-line treatment for Campylobacter infections due to its superior efficacy (96% clinical cure rate) and low resistance rates 1, 2
• Early treatment with azithromycin (within 72 hours of symptom onset) is most effective in reducing symptom duration from 50-93 hours to 16-30 hours 1
• Azithromycin is particularly preferred in regions with high fluoroquinolone resistance 1, 2

Alternative Treatment Options

• Fluoroquinolones (ciprofloxacin, levofloxacin) should only be considered in areas with known low fluoroquinolone resistance 1, 2
• Ciprofloxacin dosing: 750 mg single dose or 500 mg twice daily for 3 days 1, 3
• Levofloxacin dosing: 500 mg single dose or 500 mg daily for 3 days 1
• Fluoroquinolone resistance is widespread globally, with resistance rates exceeding 90% in Southeast Asia and increasing significantly in other regions 2

Antimicrobial Resistance Considerations

• Fluoroquinolone resistance among Campylobacter has increased dramatically worldwide, from 0% to 84% in Thailand between 1990-1995 2
• Clinical failure occurs in approximately 33% of patients treated with fluoroquinolones when the isolate is resistant 2
• Macrolide (azithromycin, erythromycin) resistance remains relatively low at around 4% for travel-related infections, though increasing resistance has been observed in some regions 2, 4
• Treatment selection should consider local resistance patterns to prevent treatment failure 1, 2

Special Populations

• Immunocompromised patients should always receive antibiotic treatment, even for mild infections, due to risk of systemic spread and recurrent infections 1, 5
• For severe infections with high fever or dysentery, azithromycin is recommended as first-line therapy 1
• Prolonged treatment courses (up to 3 months with doxycycline) may be necessary for immunocompromised patients with recurrent infections 5

Supportive Care

• Initial rehydration is critical, particularly for patients with severe diarrhea or signs of dehydration 2
• Oral rehydration solutions (e.g., Ceralyte, Pedialyte) are recommended for most patients 2
• Antimotility agents should be avoided as they may impede resolution of the infection 6, 7

Treatment Timing and Follow-up

• Most Campylobacter infections are self-limiting and resolve without specific antimicrobial treatment within 3-5 days 6, 8
• Antibiotic treatment is most beneficial when started early (within 72 hours of symptom onset) 1
• Microbiologic testing is recommended for returning travelers with severe or persistent symptoms to guide appropriate treatment 1
• Patients with persistent symptoms beyond 10-14 days warrant further evaluation 6

Common Pitfalls to Avoid

• Using fluoroquinolones empirically without considering local resistance patterns can lead to treatment failure and prolonged illness 2, 1
• Delaying treatment beyond 72 hours significantly reduces the effectiveness of antibiotics 1
• Using antimotility agents can worsen outcomes and delay resolution of infection 6, 7
• Failing to recognize potential post-infectious complications such as Guillain-Barré syndrome, reactive arthritis, or Reiter's syndrome 6, 9