Treatment of Campylobacter in Stool
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, achieving a 96% clinical cure rate. 1, 2
When to Treat vs. Observe
Most immunocompetent patients with mild symptoms do not require antibiotics, as Campylobacter infections are typically self-limiting and resolve within 3-5 days. 2 However, treatment is indicated for:
- Bloody diarrhea 2
- High fever 2
- Severe abdominal pain 2
- Symptoms lasting >1 week 2
- Any immunocompromised patient, regardless of symptom severity, due to high risk of bacteremia and systemic spread 1, 2
First-Line Treatment: Azithromycin
The Infectious Diseases Society of America recommends azithromycin as the preferred agent, particularly given widespread fluoroquinolone resistance now exceeding 90% in Southeast Asia and increasing globally. 1, 2
Dosing options:
Timing matters critically: Early treatment within 72 hours of symptom onset reduces illness duration from 50-93 hours to 16-30 hours. 1, 2 Delaying treatment beyond 72 hours significantly reduces antibiotic effectiveness. 1, 2
Alternative Treatment Options
Erythromycin can be used if azithromycin is unavailable, though it is less effective. 2 For pediatric patients, erythromycin 50 mg/kg/day divided every 6-8 hours for 5 days may be considered. 1
Fluoroquinolones (ciprofloxacin, levofloxacin) should only be used in areas with documented low fluoroquinolone resistance. 1 The FDA label indicates ciprofloxacin is approved for infectious diarrhea caused by Campylobacter jejuni. 3 However, clinical failure occurs in approximately 33% of patients when the isolate is fluoroquinolone-resistant. 1, 2 Macrolide resistance remains relatively low at around 4% for travel-related infections. 1, 2
Supportive Care
Rehydration is critical, particularly for patients with severe diarrhea or dehydration signs. 2 Oral rehydration solutions (e.g., Ceralyte, Pedialyte) are recommended for most patients. 1
Avoid antimotility agents (such as loperamide), as they may prolong bacterial shedding and worsen symptoms, particularly when bloody diarrhea or fever is present. 1, 2
Continue age-appropriate feeding as tolerated. 1, 2
Special Populations
Immunocompromised patients (including cancer patients, HIV-infected persons, those with liver cirrhosis) should always receive antibiotic treatment, even for mild infections, due to risk of bacteremia, systemic spread, and severe complications like toxic megacolon. 1, 2 These patients may require IV fluids and electrolytes for complicated diarrhea with fever, vomiting, or fluid depletion. 1
Infants under 6 months are at higher risk for severe disease and complications, warranting prompt azithromycin treatment. 1
Monitoring and Follow-Up
Reassess at 48 hours: If no improvement or worsening symptoms occur, reassess diagnosis and consider alternative antibiotics based on susceptibility testing. 1, 2
No routine follow-up stool cultures are needed if symptoms resolve. 1, 2
Diarrhea persisting beyond 10-14 days warrants further evaluation. 2
Obtain complete blood count, electrolyte profile, and comprehensive stool work-up for immunocompromised patients. 1
Critical Pitfalls to Avoid
Do not use fluoroquinolones empirically without considering local resistance patterns—this leads to treatment failure in 33% of resistant cases and prolongs illness. 1, 2
Do not delay treatment beyond 72 hours if antibiotics are indicated, as this dramatically reduces effectiveness. 1, 2
Do not discontinue antibiotics prematurely—complete the full 3-5 day course to prevent treatment failure. 1, 2
Do not use antimotility agents in suspected Campylobacter infection, especially with bloody diarrhea or fever. 1, 2
Post-Infectious Complications to Monitor
Be aware of potential complications including: