What is the recommended treatment for Campylobacter infections?

Treatment of Campylobacter Infections

Azithromycin is the first-line treatment for Campylobacter infections, given as either 1000 mg single dose or 500 mg daily for 3 days, due to its 96% clinical cure rate and low resistance rates of approximately 4%. 1, 2

Treatment Algorithm

First-Line: Azithromycin

• Dosing options: 1000 mg single dose OR 500 mg daily for 3 days 1, 2
• Timing matters: Initiate within 72 hours of symptom onset to reduce illness duration from 50-93 hours down to 16-30 hours 1, 2
• Resistance profile: Macrolide resistance remains low at ~4% for travel-related infections, though increasing trends observed in some regions like Iquitos, Peru (2.2% to 14.9%) 3, 2

Second-Line: Erythromycin

• Use only if azithromycin unavailable: 50 mg/kg/day divided every 6-8 hours for 5 days (pediatric dosing) 1
• Less effective than azithromycin but acceptable alternative 1, 2

Fluoroquinolones: Use ONLY with Known Low Local Resistance

• Ciprofloxacin: 750 mg single dose OR 500 mg twice daily for 3 days 1
• Critical caveat: Fluoroquinolone resistance now exceeds 90% in Southeast Asia, 78% in Mexico, 83% in South America 3, 1
• Clinical failure rate: 33% when treating resistant isolates with fluoroquinolones 3, 2
• FDA-approved indication: Ciprofloxacin is indicated for infectious diarrhea caused by Campylobacter jejuni 4

When to Treat vs. Observe

Mandatory Treatment Indications:

• Bloody diarrhea 2
• High fever 2
• Severe abdominal pain 2
• Symptoms >1 week 2
• Any immunocompromised patient (even mild infections due to systemic spread risk) 1, 2
• Infants <6 months (higher risk for severe disease) 1

Supportive Care Only:

• Immunocompetent patients with mild symptoms (most infections self-resolve in 3-5 days) 2

Essential Supportive Measures

• Oral rehydration solutions (Ceralyte, Pedialyte) for dehydration 1, 2
• Continue age-appropriate feeding as tolerated 1, 2
• Avoid antimotility agents (prolong bacterial shedding and worsen symptoms) 1, 2

Monitoring and Reassessment

• Reassess at 48 hours: If no improvement or worsening, obtain susceptibility testing and consider alternative antibiotics 1, 2
• No routine follow-up cultures needed if symptoms resolve 1, 2
• Further evaluation warranted if diarrhea persists beyond 10-14 days 2

Critical Pitfalls to Avoid

Resistance-Related Failures:

• Never use fluoroquinolones empirically without knowing local resistance patterns—this leads to treatment failure in 33% of resistant cases 3, 2
• Thailand example: Fluoroquinolone resistance increased from 0% (1990) to 84% (1995) 3
• US travel data: 60% of travel-related Campylobacter infections are fluoroquinolone-resistant vs. only 13% of domestic cases 3

Timing Errors:

• Delaying treatment beyond 72 hours significantly reduces azithromycin effectiveness 1, 2
• Premature antibiotic discontinuation before completing full course causes treatment failure 1, 2

Special Population Oversights:

• HIV-infected patients: Higher risk for non-jejuni/non-coli species requiring specialized testing 2
• Immunocompromised patients: Always treat even mild infections due to systemic spread risk 1, 2

Post-Infectious Complications to Monitor

• Reactive arthritis 2
• Reiter's syndrome 2
• Guillain-Barré syndrome 2

Geographic Resistance Considerations

Obtain microbiologic testing in returning travelers with severe/persistent symptoms to guide treatment and prevent prolonged illness 1. Regional resistance patterns show:

• Southeast Asia: >90% fluoroquinolone resistance 1, 2
• Peru (Lima): C. jejuni ciprofloxacin resistance 73.1% to 89.8%; C. coli 48.1% to 87.4% 3
• Macrolide resistance: Associated with increased hospitalization risk when present 3