What is the recommended treatment for Campylobacter (C.) jejuni diarrhea?

Treatment of Campylobacter jejuni Diarrhea

Azithromycin is the preferred first-line treatment for Campylobacter jejuni diarrhea, 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 should be used as first-line therapy for C. jejuni infections, especially in regions with high fluoroquinolone resistance, 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 2, 1
• For severe cases or dysentery, azithromycin 1000 mg single dose is recommended 2, 1
• For less severe cases, azithromycin 500 mg daily for 3 days is appropriate 2, 1

Alternative Treatment Options

• Fluoroquinolones (ciprofloxacin, levofloxacin) should only be used in areas with known low fluoroquinolone resistance 1
• Ciprofloxacin dosing: 750 mg single dose or 500 mg twice daily for 3 days 2, 1
• Levofloxacin dosing: 500 mg single dose or 500 mg daily for 3 days 2, 1
• Fluoroquinolone resistance among Campylobacter has increased dramatically worldwide, with resistance rates exceeding 90% in Southeast Asia 1, 3

Treatment Considerations

• Consider local resistance patterns when choosing empiric therapy 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
• Rifaximin (200 mg three times daily for 3 days) may be used for non-dysenteric, non-febrile cases, but should not be used with invasive illness 2, 4

Supportive Care

• Maintain adequate hydration with clear liquids, aiming for 8-10 large glasses daily 2
• Dietary modifications include avoiding lactose-containing products, alcohol, and high-osmolar supplements 2
• Consume bland foods such as bananas, rice, applesauce, and toast 2
• Loperamide may be used as adjunctive therapy with antibiotics to further reduce gastrointestinal symptoms and duration of illness 2, 4
• Initial dose of loperamide is 4 mg followed by 2 mg after each loose stool, not to exceed 16 mg in a 24-hour period 2

Special Populations

• Immunocompromised patients should always receive antibiotic treatment, even for mild infections, due to the risk of systemic spread 1
• Elderly patients may be more susceptible to dehydration and should be monitored closely 5
• Children under 2 years should not receive loperamide 2

Common Pitfalls to Avoid

• Using fluoroquinolones empirically without considering local resistance patterns can lead to treatment failure and prolonged illness 1, 6
• Delaying treatment beyond 72 hours can reduce the effectiveness of antibiotics 1
• Continuing use of loperamide alone, or in combination with antibiotics, in the face of worsening symptoms or development of dysentery 2
• Inadequate fluid replacement, particularly in vulnerable populations 5

When to Seek Further Medical Attention

• Presence of blood in stool or severe abdominal pain requires immediate medical attention 5
• Signs of significant dehydration, such as decreased urination, dizziness, or dry mouth 5
• Fever >38.5°C or symptoms persisting beyond 48 hours despite management 5

Most cases of Campylobacter diarrhea are self-limiting, but antibiotics can significantly reduce symptom duration and prevent complications when administered early in the course of illness 1, 7.