What is the treatment for Campylobacter in stool?

Treatment of Campylobacter Infections in Stool

Azithromycin is the preferred first-line treatment for Campylobacter infections, with a dosing regimen of 1000 mg single dose or 500 mg daily for 3 days, due to its superior efficacy and low resistance rates. 1

First-Line Treatment Options

• Azithromycin is recommended as the first-line agent for Campylobacter infections by the Infectious Diseases Society of America, with a clinical cure rate of 96% 1
• 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
• Single-dose regimen (1000 mg) or 3-day course (500 mg daily) are both effective treatment options 2, 1

Alternative Treatment Options

• Fluoroquinolones (such as ciprofloxacin) may be used in areas with known low fluoroquinolone resistance 1, 3
• Ciprofloxacin dosing: 750 mg single dose or 500 mg twice daily for 3 days 2, 1
• Erythromycin may be considered as an alternative if azithromycin is unavailable, though it is less effective 1

Treatment Considerations Based on Severity

Mild to Moderate Infection

• Most Campylobacter infections are self-limiting and may resolve without specific antimicrobial treatment 4
• Consider antibiotic therapy if symptoms are moderate to severe or if the patient is immunocompromised 2, 1

Severe Infection

• Antibiotics should always be used to treat severe Campylobacter infections (dysentery, high fever, or severe diarrhea) 2, 1
• Azithromycin is strongly preferred for severe infections, especially those with dysentery or fever 2, 1
• Immunocompromised patients should always receive antibiotic treatment, even for mild infections, due to the risk of systemic spread 2, 1

Antimicrobial Resistance Considerations

• Fluoroquinolone resistance among Campylobacter has increased dramatically worldwide, exceeding 90% in Southeast Asia 1
• Clinical failure occurs in approximately 33% of patients treated with fluoroquinolones when the isolate is resistant 1
• Macrolide (azithromycin, erythromycin) resistance remains relatively low at around 4% for travel-related infections 1
• Consider local resistance patterns when choosing empiric therapy 1

Supportive Care

• Initial rehydration is critical, particularly for patients with severe diarrhea or signs of dehydration 1
• Oral rehydration solutions are recommended for most patients 1
• Avoid antimotility agents as they may prolong bacterial shedding and worsen symptoms 1, 4

Common Pitfalls to Avoid

• Using fluoroquinolones empirically without considering local resistance patterns can lead to treatment failure and prolonged illness 1
• Delaying treatment beyond 72 hours can reduce the effectiveness of azithromycin and other antibiotics 1
• Discontinuing antibiotics prematurely before completing the full course can lead to treatment failure 1
• Failing to treat immunocompromised patients, who are at higher risk for bacteremia and extraintestinal complications 2

Follow-up

• If no improvement or worsening symptoms occur after 48 hours of treatment, reassess diagnosis and consider alternative antibiotics based on susceptibility testing 1
• No routine follow-up stool cultures are needed if symptoms resolve 1
• Diarrhea persisting beyond 10-14 days warrants further evaluation 4