What is the treatment for a 2-month-old infant with severe diarrhea and a positive stool culture for Campylobacter (C.) jejuni?

Treatment of 2-Month-Old Infant with Severe Diarrhea and Campylobacter jejuni

Immediately initiate intravenous rehydration with Ringer's lactate or normal saline at 20 mL/kg boluses to restore circulation, then transition to oral rehydration solution while considering erythromycin therapy for this young infant with documented Campylobacter jejuni infection. 1, 2

Immediate Rehydration Protocol

Severe dehydration (≥10% fluid deficit) is a medical emergency requiring immediate IV intervention. 3, 1

• Administer 20 mL/kg IV boluses of Ringer's lactate or normal saline until pulse, perfusion, and mental status normalize 1
• Continue boluses as needed to restore adequate circulation before transitioning to oral therapy 3
• Once circulation is restored, transition to oral rehydration solution (ORS) containing 50-90 mEq/L sodium to complete fluid replacement over 6-8 hours 1, 4

Ongoing Loss Replacement

• Replace each watery or loose stool with 10 mL/kg of ORS 1
• Replace each vomiting episode with 2 mL/kg of ORS 1
• If vomiting persists, administer small volumes (5 mL) every minute initially, gradually increasing as tolerated 1

Antibiotic Therapy for Campylobacter jejuni

Erythromycin is indicated for this 2-month-old infant with documented Campylobacter jejuni infection, particularly given the severe presentation. 2

• Erythromycin has demonstrated efficacy in eradicating C. jejuni and resolving symptoms, even in cases of chronic diarrhea and failure to thrive in infants 2
• Antibiotics are specifically recommended when bloody diarrhea (dysentery) or high fever is present, or when stool cultures identify a treatable pathogen like Campylobacter 1
• The young age (2 months) and severe presentation justify antibiotic treatment to prevent prolonged illness and potential complications 2

Nutritional Management

Continue breastfeeding on demand throughout the illness if the infant is breastfed. 1, 5

• For formula-fed infants, resume full-strength, lactose-free or lactose-reduced formula immediately after rehydration is achieved 1
• Do not withhold feeding while treating the infection—early refeeding prevents nutritional deterioration 1

Critical Pitfalls to Avoid

• Never delay rehydration while awaiting culture results or antibiotic initiation—start ORS or IV fluids immediately based on clinical assessment 1
• Do not use plain water, juice, or sports drinks for rehydration—these lack the appropriate sodium concentration (50-90 mEq/L) needed for effective rehydration 1
• Do not allow unrestricted drinking of large ORS volumes—this worsens vomiting; use small, frequent volumes instead 1
• Avoid antimotility drugs, antiemetics, or antidiarrheals—these are not recommended in infants with infectious diarrhea 1

Monitoring and Reassessment

• Reassess hydration status after 2-4 hours of rehydration therapy 1, 5
• Monitor for signs of persistent dehydration: prolonged skin tenting (>2 seconds), cool extremities, decreased capillary refill, altered mental status 3
• If dehydration persists, reestimate the fluid deficit and restart the rehydration protocol 5
• Watch for warning signs requiring escalation: intractable vomiting, bloody diarrhea, persistent lethargy, or decreased urine output 1

Special Considerations for Young Infants

Infants under 3 months are at particularly high risk for rapid dehydration due to higher body surface-to-weight ratio and higher metabolic rate. 3

• This 2-month-old requires especially vigilant monitoring and aggressive fluid replacement 3
• The combination of severe diarrhea with documented C. jejuni in such a young infant warrants both aggressive rehydration and antimicrobial therapy 2
• While most Campylobacter infections are self-limited and do not require antibiotics, this young age and severe presentation represent an exception where erythromycin is appropriate 6, 2