What is the recommended treatment for a patient suspected of having a Campylobacter (C.) Jejuni infection?

Treatment of Campylobacter jejuni Infection

Primary Recommendation

For suspected or confirmed C. jejuni infection, erythromycin 500 mg twice daily for 5 days is the recommended first-line treatment in immunocompetent patients. 1

When to Treat

• Most C. jejuni infections do not require antibiotic therapy, as the illness is typically self-limited and complications are rare. 2
• Antibiotics should be reserved for patients with:
  • Severe or prolonged symptoms (high fever, bloody diarrhea, >8 stools/day) 1
  • Immunocompromised status 1
  • Symptoms lasting >1 week 1
  • Pregnancy 1
  • Risk of transmission to vulnerable populations 1

Treatment Regimens

Immunocompetent Patients

• Erythromycin 500 mg orally twice daily for 5 days is the standard regimen 1
• Treatment is most effective when initiated early in the illness course (within first 3 days of symptoms) 1

Immunocompromised Patients

• Same erythromycin regimen as immunocompetent patients, but may require prolonged treatment duration depending on clinical response 1
• Close monitoring for treatment failure is essential 1

Alternative Agents (in context of resistance)

• Fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin) were historically used but should be avoided due to rapidly emerging resistance worldwide 2
• The alarming trend of antimicrobial-resistant Campylobacter strains, accelerated by antibiotic use in food animals, has made fluoroquinolone resistance a major concern 2

Critical Clinical Pitfalls

• Do not delay treatment while awaiting stool culture results in severely ill patients, particularly those with high fever, bloody diarrhea, or immunocompromised status 1
• Avoid antimotility agents (e.g., loperamide) as they may prolong illness and increase risk of complications 1
• Do not routinely prescribe antibiotics for mild, self-limited gastroenteritis, as most patients recover without antimicrobial therapy 2

Special Considerations for Inflammatory Bowel Disease

• In patients with suspected acute severe ulcerative colitis (ASUC), do not withhold corticosteroid treatment while awaiting C. jejuni stool culture results 1
• If C. jejuni is detected in a patient with ASUC, continue corticosteroids and add appropriate antimicrobial therapy 1
• Consider metronidazole in patients with recent travel to endemic areas pending stool microscopy and culture 1

Post-Infectious Sequelae Awareness

• Guillain-Barré syndrome occurs in <1 per 1,000 C. jejuni infections and is now recognized as a post-infectious complication 2
• Reactive arthritis (Reiter syndrome) is another rare post-infectious sequela 3
• These complications occur regardless of antibiotic treatment and cannot be prevented by antimicrobial therapy 2

Prevention Context

• Most infections are acquired through consumption and handling of poultry, particularly undercooked chicken 2, 3
• Cross-contamination of ready-to-eat foods after handling raw chicken is a major transmission route 4
• Careful food preparation and cooking practices are essential prevention strategies 2