From the Guidelines
Azithromycin is the recommended first-line treatment for Campylobacter jejuni infection, given its efficacy and the increasing resistance of Campylobacter spp. to fluoroquinolones. The treatment regimen typically involves 500 mg of azithromycin once daily for 3 days, or alternatively, a single 1-gm dose 1. This recommendation is based on the high level of evidence and strong expert consensus, considering the rising concern of fluoroquinolone-resistant Campylobacter spp. globally, including in areas such as Thailand, India, and parts of South America 1.
Key Considerations
- The choice of antibiotic should be guided by the severity of symptoms, with azithromycin being preferred for severe cases, including dysentery or febrile diarrhea 1.
- Fluoroquinolones, such as ciprofloxacin, may still be considered in areas with low resistance rates, but their use is generally discouraged due to the high prevalence of resistance among Campylobacter spp. 1.
- Azithromycin has been shown to be effective against a broad range of pathogens, including those causing dysentery, and has a favorable safety profile, making it a preferred option for the treatment of Campylobacter jejuni infections 1.
Treatment Approach
- For patients with mild to moderate symptoms, supportive care, including fluid and electrolyte replacement, may be sufficient, as the infection is often self-limiting within a week.
- Antibiotic therapy, specifically azithromycin, is recommended for patients with severe symptoms, including high fever, bloody diarrhea, prolonged illness, or immunocompromised status.
- Probiotics may be considered as an adjunctive therapy to help restore normal gut flora, although their effectiveness in treating Campylobacter jejuni infections is not well established 1.
From the Research
First Line Treatment for Campylobacter Jejuni
- The first line treatment for Campylobacter jejuni is azithromycin, as it has been shown to be effective in treating the infection, especially in areas where fluoroquinolone resistance is prevalent 2, 3, 4.
- Azithromycin has been compared to other antibiotics such as ciprofloxacin and levofloxacin, and has been found to have a higher cure rate and shorter time to last unformed stool 2, 3.
- The use of azithromycin is recommended due to the high rates of fluoroquinolone resistance in Campylobacter organisms, which can exceed 85% in some areas 2, 4.
- Other antibiotics such as amoxicillin-clavulanic acid have also been shown to be effective in treating Campylobacter jejuni, with high rates of susceptibility 5, 6.
- However, the use of macrolides such as azithromycin may be limited by the emergence of resistance, and alternative treatments such as amoxicillin-clavulanic acid may be considered 4, 6.
Antibiotic Resistance
- Campylobacter jejuni has been shown to be resistant to several antibiotics, including fluoroquinolones, macrolides, and tetracyclines 5, 6.
- The resistance patterns of Campylobacter jejuni can vary depending on the location and the use of antibiotics in the area 4, 6.
- The emergence of antibiotic-resistant Campylobacter jejuni is a concern, and alternative treatments such as amoxicillin-clavulanic acid may be necessary 4, 6.
Treatment Options
- Azithromycin is a recommended first-line treatment for Campylobacter jejuni, especially in areas where fluoroquinolone resistance is prevalent 2, 3, 4.
- Amoxicillin-clavulanic acid is an alternative treatment option, with high rates of susceptibility 5, 6.
- Other antibiotics such as ciprofloxacin and levofloxacin may be used, but their effectiveness may be limited by resistance 2, 3.