Do Not Give Lomotil (Diphenoxylate) for Campylobacter Infection
Lomotil (diphenoxylate with atropine) is contraindicated in Campylobacter infection and should never be used, as antimotility agents must be avoided in any suspected or proven invasive/inflammatory diarrhea to prevent bacterial proliferation, toxin accumulation, and risk of toxic megacolon. 1, 2, 3
Why Antimotility Agents Are Dangerous in Campylobacter
The FDA explicitly contraindicates diphenoxylate in "diarrhea associated with enterotoxin-producing bacteria," which includes Campylobacter as an invasive pathogen 3
Slowing intestinal motility when invasive pathogens like Campylobacter are present leads to:
The IDSA guidelines specifically state that antimotility agents should be avoided in inflammatory diarrhea or diarrhea with fever (both common features of Campylobacter infection) 1, 2
Red Flags That Absolutely Prohibit Lomotil Use
If any of these features are present, never use antimotility agents: 1, 2
- Bloody diarrhea or dysentery
- Fever (particularly >38.5°C)
- Severe abdominal pain
- Signs of invasive infection
- Suspected or confirmed Campylobacter, Shigella, Salmonella, or STEC
What to Do Instead: Proper Treatment Algorithm
First-line treatment for Campylobacter is azithromycin, not antimotility agents: 1
- Azithromycin 1000 mg single dose OR 500 mg daily for 3 days 1
- Clinical cure rate of 96% when used appropriately 1
- Most effective when started within 72 hours of symptom onset (reduces illness duration from 50-93 hours to 16-30 hours) 1
Supportive care priorities: 1
- Oral rehydration solutions (e.g., Pedialyte, Ceralyte) as first-line therapy 1
- Continue age-appropriate feeding as tolerated 1
- Monitor for signs of dehydration or systemic illness 1
Special Populations Requiring Extra Caution
Immunocompromised patients must always receive antibiotic treatment (azithromycin), even for mild Campylobacter infections, due to high risk of bacteremia and systemic spread 1
Children under 18 years should never receive antimotility agents like Lomotil for any acute diarrhea, per strong recommendations from the AAP and IDSA 2
Common Pitfall to Avoid
The most dangerous error is using Lomotil empirically before knowing the cause of diarrhea. While some guidelines note that loperamide (a different antimotility agent) may be started before culture results in certain low-risk scenarios, this applies only to uncomplicated watery diarrhea in immunocompetent adults without fever or blood in stool 2. Diphenoxylate (Lomotil) has a narrower safety profile than loperamide and should be avoided entirely when invasive pathogens are suspected. 3, 4