From the Guidelines
Azithromycin is the recommended treatment for acute diarrhea with stool studies positive for Campylobacter species (Campylobacter sp) Polymerase Chain Reaction (PCR).
Key Considerations
- The decision to treat is based on the severity of illness and the presence of symptoms such as fever, abdominal pain, or vomiting.
- Azithromycin is recommended as the first-line agent due to its efficacy and safety profile, particularly in cases of dysentery or febrile diarrhea 1.
- The dose of azithromycin is typically 1000 mg by mouth as a single dose or 500 mg by mouth for 3 days 1.
- Fluoroquinolones may also be effective, but their use is limited by the increasing prevalence of resistance, particularly in Campylobacter species 1.
- Rifaximin is not recommended for the treatment of invasive pathogens such as Campylobacter, as it is less effective in achieving clinical cure 1.
Special Considerations
- In immunocompromised patients, treatment with azithromycin may be considered, even in the absence of severe symptoms 1.
- In cases of suspected Shiga toxin-producing E. coli (STEC), antibiotic treatment should be avoided due to the risk of worsening the infection 1.
- The choice of antimicrobial agent may change due to evolving resistance patterns, and local epidemiology should be taken into account when selecting an antibiotic 1.
From the Research
Management of Acute Diarrhea with Stool Studies Positive for Campylobacter Species
The management of acute diarrhea with stool studies positive for Campylobacter species (Campylobacter sp) Polymerase Chain Reaction (PCR) involves several considerations:
- Administration of antibiotics may be indicated in certain cases, such as febrile diarrhea or moderate to severe disease 2
- Azithromycin may be an appropriate empirical treatment for acute diarrhea when indicated, especially in regions with high incidence of C. jejuni and resistance to quinolones 2
- Stool multiplex bacterial PCR testing can be a useful tool for identifying bacterial etiology in patients with acute diarrhea, especially in those with Campylobacter spp. infection 3
- Rectal biopsy may have an important diagnostic role in patients with acute diarrhea, particularly in those with negative cultures 4
Diagnostic Considerations
- PCR assays can detect and identify C. jejuni, C. coli, Salmonella, and Yersinia species and Shigella and enteroinvasive E. coli in stool samples with high sensitivity and specificity 5
- Positive Campylobacter stool PCR test with negative culture results may challenge clinicians and require careful interpretation in the clinical context 6
- Co-infections are more common in culture negative/PCR positive samples than in culture positive samples, and clinical characteristics may differ significantly between groups 6
Clinical Interpretation
- Positive PCR results for campylobacter and EPEC should be interpreted in a clinical context after evaluation of non-infectious diarrhoea associated conditions, and cannot be used as a stand-alone diagnostic tool 6
- Clinicians should consider the clinical significance of positive Campylobacter and/or EPEC test results in hospitalised patients with diarrhoea, taking into account the presence of co-infections and non-infectious causes of diarrhea 6