What is the significance of Campylobacter in stool?

From the Guidelines

Campylobacter in stool typically requires antibiotic treatment, such as azithromycin (500 mg once daily for 3 days) or ciprofloxacin (500 mg twice daily for 5-7 days), for moderate to severe cases, as it has been shown to reduce the duration of symptoms by an average of 1 day compared to placebo 1. When considering treatment, it's essential to weigh the benefits and risks, as the majority of cases are self-limited and may not require antibiotic treatment. However, for patients with prolonged or severe disease, or those who are immunocompromised, treatment is recommended to reduce the risk of complications and mortality. Some key points to consider when treating Campylobacter infections include:

• The choice of antimicrobial agent may change due to evolving resistance patterns, with fluoroquinolone resistance being a concern in many countries 1.
• Treatment should be started early in the course of the illness to maximize its effectiveness, and the use of CIDT can facilitate organism identification and guide treatment decisions.
• Patients should be advised to maintain good fluid intake to prevent dehydration, consume bland foods, and avoid dairy, fatty foods, and spicy dishes that may worsen symptoms.
• Strict hand hygiene should be practiced to prevent spreading the infection to others, as Campylobacter infection can be transmitted through contaminated food, water, or person-to-person contact. It's also important to note that while antibiotic treatment can reduce the duration of symptoms, it may also be accompanied by an increase in prolonged Salmonella shedding and occasional shedding of quinolone-resistant Campylobacter, highlighting the need for careful consideration of treatment decisions 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. The presence of Campylobacter in stool indicates a potential infection that may be treated with ciprofloxacin, if antibacterial therapy is indicated 2.

From the Research

Campylobacter in Stool

• Campylobacteriosis is a collective term for infectious, emerging foodborne disease caused by Campylobacter species, which are Gram-negative, curved, and microaerophilic pathogens 3.
• The true incidence of human campylobacteriosis is unknown for most countries, but it is an important issue due to its increasing incidence in many countries 3.
• Animals such as birds are the main sources of infection, and farm animals like cattle and poultry can become infected, leading to contaminated raw milk, undercooked or poorly handled meat, and transmission to humans through consumption of infected food or water 3.
• Campylobacter infections can be prevented by simple hygienic food handling practices, and early diagnosis is crucial for a favorable outcome 3.

Transmission and Prevention

• Transmission of campylobacteriosis to humans occurs through consumption of infected, unpasteurized animal milk and milk products, undercooked poultry, and contaminated drinking water 3.
• Contact with contaminated poultry, livestock, or household pets can also cause disease 3.
• Antibiotic treatment is controversial and has only a benefit on the duration of symptoms 3.

Treatment and Antibiotic Resistance

• Azithromycin is effective in treating Campylobacter enteritis, especially in areas where ciprofloxacin resistance is prevalent 4.
• Amoxicillin and clavulanic acid have been proposed as a treatment for campylobacteriosis due to their high susceptibility rates 5.
• There is a high incidence of quinolone- and macrolide-resistant Campylobacter infections, especially in infants under 24 months of age 5.
• Macrolides, such as azithromycin and erythromycin, show excellent activity against Campylobacter jejuni, with low frequencies of resistance 6.
• Antimicrobial resistance in Campylobacter species is a major public health problem, with increasing resistance to macrolides, fluoroquinolones, and other classes of antimicrobial drugs 7.