What is the treatment for campylobacter (campylobacteriosis) stool infection?

Treatment of Campylobacter Stool Infection

Azithromycin is the first-line antibiotic for treating Campylobacter stool infections, with a dosing regimen of either 1000 mg as a single dose or 500 mg daily for 3 days. 1, 2

When to Treat with Antibiotics

Not all Campylobacter infections require antibiotics, as most are self-limiting and resolve within 3-5 days. 1 However, antibiotic treatment is strongly indicated for:

• Severe disease presentations: bloody diarrhea, high fever, severe abdominal pain, or symptoms lasting >1 week 1
• Immunocompromised patients: always treat, even with mild symptoms, due to risk of systemic spread 1, 2
• Dysentery or febrile diarrhea: these presentations warrant immediate antibiotic therapy 3
• Patients with compromised host defenses: including those with malnutrition, immunodeficiency, or malignancy 4, 5

First-Line Treatment: Azithromycin

The Infectious Diseases Society of America recommends azithromycin as first-line therapy with a 96% clinical cure rate. 1, 2 This recommendation is driven by:

• Superior efficacy in regions with high fluoroquinolone resistance (exceeding 90% in Southeast Asia) 3, 1
• Low macrolide resistance rates (approximately 4% for travel-related infections) 1, 2
• Optimal timing: Treatment within 72 hours of symptom onset reduces duration from 50-93 hours to 16-30 hours 1, 2

Dosing options:

• Single 1000 mg dose, OR 3, 2
• 500 mg daily for 3 days 3, 2

Alternative Treatment: Erythromycin

Erythromycin 50 mg/kg/day divided every 6-8 hours for 5 days may be used if azithromycin is unavailable, though it is less effective. 2, 4

When Fluoroquinolones May Be Considered

Fluoroquinolones should only be used in areas with documented low fluoroquinolone resistance and for non-dysenteric presentations. 3, 2 The FDA approves ciprofloxacin for infectious diarrhea caused by Campylobacter jejuni. 6

Critical caveat: Clinical failure occurs in approximately 33% of patients when the Campylobacter isolate is fluoroquinolone-resistant. 1, 2 Fluoroquinolone resistance has increased dramatically worldwide, from 0% to 84% in Thailand between 1990-1995. 2

If using fluoroquinolones:

• Ciprofloxacin: 750 mg single dose or 500 mg twice daily for 3 days 2, 6
• Levofloxacin: 500 mg single dose or daily for 3 days 3, 2

Do NOT use fluoroquinolones if:

• Clinical suspicion for invasive diarrhea (dysentery, fever) 3
• Travel to Southeast Asia or India where resistance exceeds 90% 3, 1
• Campylobacter is suspected based on clinical presentation 3

Essential Supportive Care

Rehydration is critical, particularly for patients with severe diarrhea or dehydration signs. 1, 2

• Oral rehydration solutions (e.g., Gatorade, broth, Ceralyte, Pedialyte) are recommended for most patients 3, 1, 2
• Intravenous fluids for severely dehydrated patients 3, 7
• Continue age-appropriate feeding as tolerated 1, 2
• Avoid antimotility agents (like loperamide) as they may prolong bacterial shedding and worsen symptoms 1, 2

Special Populations

Infants under 6 months are at higher risk for severe disease and complications, warranting prompt azithromycin treatment. 2

Cancer patients and immunocompromised individuals: While Campylobacter is rare in this population (0-2.8% incidence), severely ill or immunocompromised patients should receive systemic treatment. 3 For cancer patients, azithromycin is preferred given fluoroquinolone resistance patterns. 3

Monitoring and Follow-Up

• Reassess at 48 hours: If no improvement or worsening symptoms, consider alternative antibiotics based on susceptibility testing 1, 2
• No routine follow-up stool cultures needed if symptoms resolve 1, 2
• Diarrhea persisting beyond 10-14 days warrants further evaluation 1
• Monitor for post-infectious complications: reactive arthritis, Guillain-Barré syndrome, Miller Fisher syndrome 3, 5

Critical Pitfalls to Avoid

Using fluoroquinolones empirically without considering local resistance patterns leads to treatment failure in 33% of resistant cases and prolongs illness. 1, 2 This is the single most common treatment error.

Delaying treatment beyond 72 hours significantly reduces antibiotic effectiveness. 1, 2 Early recognition and prompt initiation of azithromycin is essential for optimal outcomes.

Discontinuing antibiotics prematurely before completing the full course leads to treatment failure. 1, 2 Complete the 3-day course even if symptoms improve rapidly.

Using antimotility agents can worsen outcomes by prolonging bacterial shedding and potentially causing complications. 1, 2