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, self-limited disease in immunocompetent patients:

• Most Campylobacter infections resolve spontaneously within 3-5 days without antimicrobial therapy 1
• Consider supportive care alone for immunocompetent patients with mild symptoms 1

Antibiotic treatment is indicated for:

• Bloody diarrhea 1
• High fever 1
• Severe abdominal pain 1
• Symptoms persisting >1 week 1
• Any degree of illness in immunocompromised patients (including HIV-infected persons), even mild infections, due to risk of systemic spread and bacteremia 3, 1, 4
• Infants under 6 months, who are at higher risk for severe disease and complications 2

First-Line Treatment: Azithromycin

Dosing regimens:

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

Timing is critical:

• Treatment must be initiated within 72 hours of symptom onset for maximum effectiveness 1, 2
• Early treatment reduces symptom duration from 50-93 hours down to 16-30 hours 1, 2
• Delaying treatment beyond 72 hours significantly reduces antibiotic effectiveness 1, 2

Alternative Treatment Options

Erythromycin (second-line):

• Can be used if azithromycin is unavailable, though less effective 1
• Pediatric dosing: 50 mg/kg/day divided every 6-8 hours for 5 days 2

Fluoroquinolones (ciprofloxacin, levofloxacin):

• Only use in areas with documented low fluoroquinolone resistance 1, 2
• Ciprofloxacin: 750 mg single dose or 500 mg twice daily for 3 days 2
• Levofloxacin: 500 mg single dose or 500 mg daily for 3 days 2
• FDA-approved for infectious diarrhea caused by Campylobacter jejuni 5

Critical Resistance Considerations

Why fluoroquinolones should NOT be used empirically:

• Fluoroquinolone resistance exceeds 90% in Southeast Asia 1, 2
• Resistance rates have increased dramatically worldwide from 0% to 84% in some regions 2
• Clinical failure occurs in approximately 33% of patients when the isolate is resistant 1, 2
• Using fluoroquinolones empirically without considering local resistance patterns leads to treatment failure and prolonged illness 1, 2, 4

Macrolide resistance remains low:

• Azithromycin/erythromycin resistance is only ~4% for travel-related infections 1, 2

Special Populations

HIV-infected and immunocompromised patients:

• Always treat, even for mild infections 1, 4
• Higher risk for bacteremia and systemic spread 3, 4
• At increased risk for non-jejuni non-coli Campylobacter species (C. fetus, C. upsaliensis, C. lari) 4
• May experience more severe and prolonged disease with risk of relapse 4
• For patients with CD4+ counts >200 cells/µL: treat for 7-14 days 3
• For patients with CD4+ counts <200 cells/µL: treat for 2-6 weeks 3
• For bacteremia: treat for >2 weeks, consider adding aminoglycoside as second agent 3

Infants and children:

• Infants under 6 months warrant prompt treatment with azithromycin due to higher risk for severe disease 2
• Ciprofloxacin is FDA-approved for complicated UTI/pyelonephritis in pediatric patients 1-17 years, but is not first-choice due to increased joint-related adverse events 5

Supportive Care (Essential for All Patients)

• Rehydration is critical, particularly for severe diarrhea or signs of dehydration 1, 2, 4
• Oral rehydration solutions (e.g., Ceralyte, Pedialyte) recommended for most patients 1, 2
• Avoid antimotility agents - they prolong bacterial shedding and worsen symptoms 1, 2, 4
• Continue age-appropriate feeding as tolerated 1, 2

Monitoring and Follow-Up

• Reassess diagnosis and consider alternative antibiotics based on susceptibility testing if no improvement or worsening occurs after 48 hours of treatment 1, 2
• No routine follow-up stool cultures needed if symptoms resolve 1, 2
• Diarrhea persisting beyond 10-14 days warrants further evaluation 1
• Obtain blood cultures from patients with fever and diarrhea, especially if immunocompromised, due to high bacteremia rates 4

Common Pitfalls to Avoid

• Using fluoroquinolones empirically without considering local resistance patterns - leads to treatment failure in 33% of resistant cases 1, 2, 4
• Delaying treatment beyond 72 hours - dramatically reduces effectiveness of azithromycin and other antibiotics 1, 2
• Discontinuing antibiotics prematurely before completing the full course - leads to treatment failure 1, 2
• Failing to notify laboratory of suspected Campylobacter infection - standard protocols may miss non-jejuni non-coli species that require special culture conditions 4
• Using antimotility agents - prolongs bacterial shedding and worsens clinical course 1, 2, 4

Post-Infectious Complications to Monitor

• Reactive arthritis 1
• Reiter's syndrome 1, 6
• Guillain-Barré syndrome (occurs in approximately 1 in 1000 infections) 1, 7, 6
• Pancreatitis 6