What is the treatment for Campylobacter (campylobacteriosis) infection?

From the Guidelines

Azithromycin should be considered the first-line agent for the treatment of Campylobacter infections, particularly in cases of dysentery or acute watery diarrhea with greater than mild fever, due to its high efficacy and low resistance rates compared to fluoroquinolones 1. When treating Campylobacter infections, it is essential to consider the severity of the illness and the potential for antibiotic resistance.

• For moderate to severe infections, azithromycin (500mg daily for 3 days) is the preferred antibiotic, as it has been shown to be superior to levofloxacin in achieving clinical cure, especially in areas with high rates of fluoroquinolone-resistant Campylobacter spp. 1.
• Fluid replacement is crucial to prevent dehydration, especially in patients with severe diarrhea, and patients should drink plenty of clear fluids or oral rehydration solutions.
• Antimotility medications like loperamide should be avoided as they can prolong the infection.
• Most patients recover completely with appropriate treatment, though symptoms may persist for up to two weeks in some cases.
• Antibiotic resistance is increasing in Campylobacter strains, particularly to fluoroquinolones, so healthcare providers may need to adjust treatment based on local resistance patterns 1.
• Prevention measures include proper food handling, thorough cooking of poultry, and good hand hygiene to avoid reinfection or transmission to others. In addition to azithromycin, other antibiotics such as ciprofloxacin may be considered, but their use should be guided by local resistance patterns and the severity of the illness 1. It is also important to note that the treatment of Campylobacter infections in immunocompromised patients may require a different approach, and the use of antibiotics such as azithromycin or ciprofloxacin should be guided by the patient's specific condition and the severity of the illness 1.

From the FDA Drug Label

Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.

Ciprofloxacin is indicated for the treatment of infectious diarrhea caused by Campylobacter jejuni when antibacterial therapy is indicated 2.

From the Research

Treatment Options for Campylobacter

• Azithromycin has been shown to be effective in treating Campylobacter infections, particularly in areas where ciprofloxacin resistance is prevalent 3.
• Macrolides, such as erythromycin, clarithromycin, or azithromycin, are considered the drugs of choice for the treatment of severe Campylobacter infection 4.
• Fluoroquinolones, such as ciprofloxacin, are also commonly used for empirical treatment of undiagnosed diarrheal disease, but resistance to these drugs is increasing 4.

Antibiotic Resistance

• Resistance to azithromycin and ciprofloxacin is a major public health problem, with over 300,000 infections per year caused by drug-resistant Campylobacter in the US 4.
• A study found that 77.4% of C. jejuni isolates and 79.8% of non-C. jejuni isolates were resistant to ciprofloxacin, while 4.9% of C. jejuni isolates and 24.8% of non-C. jejuni isolates were not susceptible to azithromycin 5.
• Amoxicillin and clavulanic acid has been proposed as a treatment for campylobacteriosis due to its high rates of susceptibility 5.

Clinical Trials

• A randomized, double-blinded, placebo-controlled clinical trial found no differences in clinical outcomes between azithromycin treatment and placebo for Campylobacter concisus diarrhea in adults, but the study was underpowered due to recruitment difficulties 6.
• Another study found that azithromycin was as effective as ciprofloxacin in decreasing the duration of illness and the number of stools in patients with Campylobacter infection 3.

Susceptibility of Campylobacter Species

• The MICs of 21 antimicrobial agents were determined for 97 clinical isolates of Campylobacter pylori, and the results showed that azithromycin and other macrolides had low MIC90 values 7.
• The study also found that all isolates were resistant to vancomycin, cefsulodin, and amphotericin B, while aztreonam, flucloxacillin, amifloxacin, and rifampicin had moderate activity 7.