Treatment of Campylobacter Infection
Azithromycin is the preferred first-line treatment for Campylobacter infections, dosed at either 1000 mg as a single dose or 500 mg daily for 3 days. 1
First-Line Antibiotic Therapy
Azithromycin demonstrates superior efficacy with a 96% clinical cure rate and maintains low resistance rates (approximately 4%), making it the drug of choice recommended by the Infectious Diseases Society of America. 1
Start treatment within 72 hours of symptom onset for maximum benefit—early azithromycin reduces illness duration from 50-93 hours down to 16-30 hours. 1
Fluoroquinolones (ciprofloxacin, levofloxacin) should be avoided as empiric therapy due to widespread resistance exceeding 90% in regions like Southeast Asia, with clinical failure occurring in approximately 33% of patients when the isolate is resistant. 1
When to Treat vs. Observe
Antibiotic treatment is indicated for:
- Severe symptoms including high fever, bloody diarrhea (dysentery), or signs of systemic illness 1
- Immunocompromised patients, even with mild infections, due to risk of bacteremia and systemic spread 1
- Infants under 6 months who are at higher risk for severe disease and complications 1
- Symptoms persisting beyond 3-5 days 1
Observation without antibiotics is reasonable for:
- Mild, self-limited diarrhea in immunocompetent patients, as most infections resolve spontaneously 1, 2
- Cases where symptoms are already improving by the time of diagnosis 2
Alternative Antibiotic Options
Ciprofloxacin (750 mg single dose or 500 mg twice daily for 3 days) may be used only in geographic areas with documented low fluoroquinolone resistance. 1, 3
Erythromycin (50 mg/kg/day divided every 6-8 hours for 5 days in pediatrics) is a less effective alternative if azithromycin is unavailable. 1
Supportive Care Measures
Initiate oral rehydration with solutions like Ceralyte or Pedialyte for patients with moderate to severe diarrhea or dehydration signs. 1
Continue age-appropriate feeding as tolerated; avoid prolonged fasting. 1
Avoid antimotility agents (loperamide, opioids) as they may prolong bacterial shedding, worsen symptoms, and increase risk of complications in invasive diarrhea. 4, 1
Special Populations and Complicated Cases
For immunocompromised patients (including cancer patients):
Always treat with antibiotics regardless of symptom severity due to high risk of bacteremia and systemic complications. 4, 1
Consider hospitalization for patients with neutropenia, sepsis, bleeding, or severe dehydration. 4
Obtain complete blood count, electrolyte profile, and comprehensive stool work-up including culture for Campylobacter, C. difficile, Salmonella, and E. coli. 4
For complicated diarrhea with fever, vomiting, or fluid depletion:
Administer IV fluids and electrolytes as needed. 4
Consider octreotide (100-150 μg subcutaneously three times daily or 25-50 μg/hour IV) for severe, refractory cases, with dose escalation up to 500 μg subcutaneously three times daily. 4
Monitoring and Follow-Up
Reassess at 48 hours if no improvement occurs; consider alternative diagnoses or antibiotic susceptibility testing. 1
Watch for post-infectious complications including Guillain-Barré syndrome (most important), reactive arthritis, and Reiter's syndrome, which can develop even after gastrointestinal symptoms resolve. 1
No routine follow-up stool cultures are needed if symptoms resolve completely. 1
Refer for further evaluation if diarrhea persists beyond 10-14 days. 1
Critical Pitfalls to Avoid
Do not use fluoroquinolones empirically without knowing local resistance patterns—this leads to treatment failure in up to one-third of cases with resistant strains. 1
Do not delay antibiotic treatment beyond 72 hours in patients requiring therapy, as effectiveness decreases significantly. 1
Do not discontinue antibiotics prematurely before completing the full 3-5 day course, as this can lead to treatment failure. 1
Do not prescribe antimotility agents in suspected Campylobacter infection, particularly when bloody diarrhea or fever is present. 4, 1