What is the treatment for Campylobacter infection?

Treatment of Campylobacter Infection

Azithromycin is the first-line treatment for Campylobacter infections, with a dosing regimen of either 1000 mg as a single dose or 500 mg daily for 3 days, achieving a 96% clinical cure rate. 1, 2

When to Treat vs. Observe

Mild to Moderate Disease:

• Most Campylobacter infections are self-limiting and resolve without antibiotics within 3-5 days in immunocompetent patients 1
• For mild symptoms without concerning features, supportive care alone may be appropriate 1

Indications for Antibiotic Treatment:

• Bloody diarrhea 1
• High fever 1
• Severe abdominal pain 1
• Symptoms persisting >1 week 1
• Any immunocompromised patient, even with mild symptoms, due to risk of systemic spread 1, 2, 3
• Infants under 6 months (higher risk for severe disease and complications) 2

First-Line Treatment

Azithromycin is preferred over fluoroquinolones due to dramatically increasing fluoroquinolone resistance worldwide, which now exceeds 90% in Southeast Asia and causes clinical failure in approximately 33% of treated patients when the isolate is resistant 1, 2, 3

Dosing:

• 1000 mg single dose, OR
• 500 mg daily for 3 days 1, 2

Timing is critical: Early treatment within 72 hours of symptom onset reduces symptom duration from 50-93 hours to 16-30 hours; delaying beyond 72 hours significantly reduces antibiotic effectiveness 1, 2, 3

Alternative Treatment Options

Erythromycin:

• 50 mg/kg/day divided every 6-8 hours for 5 days (pediatric dosing) 2
• Can be used if azithromycin is unavailable, though less effective 1, 2
• Macrolide resistance remains relatively low at around 4% for travel-related infections 2, 3

Fluoroquinolones (Ciprofloxacin):

• Only use in areas with documented low fluoroquinolone resistance 2, 3
• 750 mg single dose or 500 mg twice daily for 3 days 2
• FDA-approved for infectious diarrhea caused by Campylobacter jejuni 4
• Critical pitfall: Using fluoroquinolones empirically without considering local resistance patterns leads to treatment failure and prolonged illness 1, 2, 3

Special Populations

HIV-Infected and Immunocompromised Patients:

• Always treat, even for mild infections 5, 1, 2, 3
• For mild-to-moderate disease: initiate fluoroquinolone or macrolide for 7 days, pending susceptibility results 5
• For bacteremia: treat for >2 weeks, consider adding a second agent (e.g., aminoglycoside) 5
• Higher risk for non-jejuni non-coli Campylobacter species (C. fetus, C. upsaliensis, C. lari) requiring special culture conditions 5, 3
• More severe and prolonged disease with risk of relapse after appropriate treatment 3

Infants and Children:

• Prompt treatment warranted, especially under 6 months of age 2
• Azithromycin preferred; erythromycin alternative if unavailable 2

Supportive Care

Rehydration:

• Critical for patients with severe diarrhea or dehydration signs 1, 2, 3
• Oral rehydration solutions (e.g., Ceralyte, Pedialyte) recommended for most patients 2, 3

What to Avoid:

• Do not use antimotility agents as they prolong bacterial shedding and worsen symptoms 1, 2, 3
• Continue age-appropriate feeding as tolerated 1, 2

Monitoring and Follow-Up

Assessment of Treatment Response:

• If no improvement or worsening after 48 hours, reassess diagnosis and 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

Post-Infectious Complications to Monitor:

• Reactive arthritis 1
• Reiter's syndrome 1
• Guillain-Barré syndrome 1

Critical Pitfalls to Avoid

1. Empiric fluoroquinolone use without resistance data: Leads to 33% treatment failure rate in resistant strains 1, 2, 3

2. Delaying treatment beyond 72 hours: Significantly reduces antibiotic effectiveness 1, 2, 3

3. Premature antibiotic discontinuation: Completing the full course is essential to prevent treatment failure 1, 2

4. Missing non-jejuni species in immunocompromised patients: Standard laboratory protocols may fail to identify these; notify lab if Campylobacter suspected 5, 3

5. Treating mild disease in immunocompetent patients unnecessarily: Most cases are self-limiting 1