Treatment of Campylobacter Infections
Azithromycin is the preferred 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. 1, 2
First-Line Treatment: Azithromycin
- Azithromycin achieves a 96% clinical cure rate and maintains low resistance rates (approximately 4%) compared to fluoroquinolones. 1, 3
- The single 1000 mg dose is recommended for severe cases with high fever or dysentery. 2
- The 500 mg daily for 3 days regimen is appropriate for less severe presentations. 2
- Early treatment within 72 hours of symptom onset is critical—this reduces symptom duration from 50-93 hours to 16-30 hours. 1, 2
- Treatment initiated after 72 hours shows significantly reduced effectiveness. 1, 2
Alternative Treatment: Fluoroquinolones (Use with Caution)
- Fluoroquinolones should ONLY be used in geographic areas with documented low resistance rates. 1, 2
- Ciprofloxacin is FDA-approved for infectious diarrhea caused by Campylobacter jejuni, with dosing of 750 mg single dose or 500 mg twice daily for 3 days. 4
- Levofloxacin dosing: 500 mg single dose or 500 mg daily for 3 days. 2
- Fluoroquinolone resistance exceeds 90% in Southeast Asia and is increasing globally—clinical failure occurs in approximately 33% of patients when the isolate is resistant. 1, 2
- In Thailand, resistance increased from 0% to 84% between 1990-1995, and azithromycin demonstrated zero treatment failures compared to multiple failures with ciprofloxacin. 3
Supportive Care
- Maintain hydration with 8-10 large glasses of clear liquids daily. 2
- Implement dietary modifications: avoid lactose-containing products, alcohol, and high-osmolar supplements. 2
- Consume bland foods (bananas, rice, applesauce, toast). 2
- Never use antimotility agents—they prolong bacterial shedding and worsen symptoms. 1
Special Populations Requiring Treatment
- Immunocompromised patients must always receive antibiotic treatment, even for mild infections, due to risk of bacteremia and systemic spread. 1, 2
- Infants under 6 months are at higher risk for severe disease and warrant prompt azithromycin treatment. 1
- For infants, 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. 1
When Antibiotics May Not Be Necessary
- For immunocompetent patients with mild, uncomplicated disease presenting after 4+ days of symptoms, antibiotics shorten illness by only 1.32 days. 5
- Erythromycin eradicates bacteria from stool but does not alter the natural course when started 4+ days after symptom onset. 6
- However, early treatment (within 72 hours) provides substantial benefit. 1, 2
Monitoring and Follow-Up
- Reassess if no improvement or worsening occurs after 48 hours of treatment—consider alternative antibiotics based on susceptibility testing. 1
- No routine follow-up stool cultures are needed if symptoms resolve. 1
- Monitor for post-infectious complications: Guillain-Barré syndrome, reactive arthritis, Reiter's syndrome, and rarely hemolytic-uremic syndrome. 1
Critical Pitfalls to Avoid
- Using fluoroquinolones empirically without considering local resistance patterns leads to treatment failure in one-third of cases. 1, 2
- Delaying treatment beyond 72 hours dramatically reduces antibiotic effectiveness. 1, 2
- Discontinuing antibiotics prematurely before completing the full course can lead to treatment failure. 1
- Children under 2 years should not receive loperamide. 2