What is the treatment for Campylobacter infection?

Treatment of Campylobacter Infection

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 treatment 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
• The American College of Physicians and the Infectious Diseases Society of America support azithromycin as the preferred treatment, especially in regions with high fluoroquinolone resistance 1

Alternative Treatment Options

• Fluoroquinolones (e.g., ciprofloxacin) are only recommended in areas with known low fluoroquinolone resistance, with dosing regimens of 750 mg single dose or 500 mg twice daily for 3 days 1, 2
• Doxycycline may be considered for Campylobacter fetus infections when other options are not available 3
• Erythromycin can be used as an alternative if azithromycin is unavailable, although it is less effective 1

Treatment Considerations Based on Disease Severity

Mild to Moderate Disease

• Most Campylobacter infections are self-limiting and resolve without specific antimicrobial treatment within 3-5 days 4
• Consider supportive care only for immunocompetent patients with mild symptoms 5

Severe Disease

• Antibiotic treatment is indicated for patients with:
  • Bloody diarrhea 5
  • High fever 1
  • Severe abdominal pain 5
  • Prolonged symptoms (>1 week) 5
  • Immunocompromised status 1

Special Populations

• Immunocompromised patients should always receive antibiotic treatment, even for mild infections, due to the risk of systemic spread 1
• HIV-infected persons are at higher risk for infection with non-jejuni non-coli Campylobacter species and may require specialized testing and treatment 5
• For patients with Salmonella bacteremia, treatment with a combination of ceftriaxone plus ciprofloxacin is recommended initially before resistance test results are available 5

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 4
• Continue age-appropriate feeding as tolerated 1

Monitoring and 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

Common Pitfalls and Caveats

• 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
• Be aware of potential post-infectious complications such as reactive arthritis, Reiter's syndrome, and Guillain-Barré syndrome 4, 6