Treatment of Campylobacter Infection
Azithromycin is the 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
When to Treat vs. Observe
Most Campylobacter infections are self-limiting and resolve without antibiotics within 3-5 days in immunocompetent patients with mild symptoms. 2 However, antibiotic treatment is indicated for:
- Severe disease: bloody diarrhea, high fever (>101.5°F), severe abdominal pain, or symptoms lasting >1 week 2
- Immunocompromised patients: always treat, even for mild infections, due to high risk of bacteremia and systemic spread 1, 2
- Early presentation: treatment within 72 hours of symptom onset reduces illness duration from 50-93 hours to 16-30 hours 1, 2
First-Line Treatment: Azithromycin
The Infectious Diseases Society of America recommends azithromycin as first-line therapy with a 96% clinical cure rate and low resistance rates (approximately 4%). 1, 2
Dosing options:
Azithromycin is superior to fluoroquinolones due to widespread fluoroquinolone resistance exceeding 90% in Southeast Asia and increasing globally. 1, 2
Alternative Treatment Options
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, 2
Fluoroquinolones (ciprofloxacin 500-750 mg) should only be used in areas with documented low fluoroquinolone resistance, as clinical failure occurs in approximately 33% of patients when the isolate is resistant. 1, 3
Supportive Care Measures
Rehydration is critical, particularly for patients with severe diarrhea or dehydration signs. 2
- Use oral rehydration solutions (e.g., Pedialyte, Ceralyte) for most patients 1
- Administer IV fluids for complicated cases with severe dehydration, vomiting, or inability to tolerate oral intake 4
Avoid antimotility agents (loperamide, diphenoxylate) as they may prolong bacterial shedding and worsen outcomes, particularly with bloody diarrhea or fever. 1, 2
Continue age-appropriate feeding as tolerated. 1
Special Populations
Immunocompromised Patients
Always treat with antibiotics regardless of symptom severity due to risk of bacteremia (up to 19% in cancer patients) and systemic complications. 1, 2
- Consider hospitalization for complicated cases with fever, severe vomiting, or fluid depletion 4
- Obtain complete blood count, electrolyte profile, and comprehensive stool work-up including culture for Campylobacter, C. difficile, Salmonella, and E. coli 4, 1
- For severe, refractory diarrhea, octreotide may be considered with dose escalation up to 500 μg subcutaneously three times daily 4
Pediatric Patients
Infants under 6 months are at higher risk for severe disease and warrant prompt treatment with azithromycin. 1
Monitoring and Follow-Up
Reassess diagnosis and consider alternative antibiotics based on susceptibility testing if no improvement or worsening symptoms occur after 48 hours of treatment. 1, 2
No routine follow-up stool cultures are needed if symptoms resolve. 1, 2
Diarrhea persisting beyond 10-14 days warrants further evaluation to rule out complications or alternative diagnoses. 5, 2
Critical Pitfalls to Avoid
Do not use fluoroquinolones empirically without considering local resistance patterns, as this leads to treatment failure in 33% of resistant cases and prolonged illness. 1, 2
Do not delay treatment beyond 72 hours, as this significantly reduces antibiotic effectiveness. 1, 2
Do not discontinue antibiotics prematurely before completing the full 3-5 day course, as this leads to treatment failure. 1, 2
Do not use antimotility agents when bloody diarrhea or fever is present, as this worsens outcomes. 1, 2
Post-Infectious Complications to Monitor
Be aware of potential late complications including Guillain-Barré syndrome, reactive arthritis, and Reiter's syndrome, which can develop even after gastrointestinal symptoms resolve. 1, 5, 2
Rare severe complications include bacteremia, hemolytic-uremic syndrome, ileus, toxic megacolon, and perforation. 1