Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

gastroenteritis

1st line – fluid replacement therapy

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1st line – 

fluid replacement therapy

The most common complication of diarrhoeal illnesses is dehydration. Initial treatment in every patient with Campylobacterinfection begins with hydration.[14]

For patients who can take oral liquid, rehydration with increased fluids or oral rehydration solutions (ORS) - consisting of water, sugars, and electrolytes - are recommended. One systematic review found polymer-based ORS had advantages over glucose-based ORS, but the analysis was underpowered.[40] For those unable to tolerate oral fluids due to nausea and vomiting, intravenous fluids should be administered, and the electrolyte balance monitored closely.

Consider – antibiotics

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ACUTE
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gastroenteritis
Consider – 

antibiotics

Additional treatment recommended for SOME patients in selected patient group

Antibiotics are not indicated in uncomplicated cases.[14]​​[41]

Indications for antimicrobial therapy include high fever, systemic infection with suspected or sustained bacteraemia, grossly bloody diarrhoea, and persistence of symptoms for >1 week. Antibiotics are also indicated in immunocompromised patients.

Macrolides (e.g., azithromycin, erythromycin) are generally the treatment of choice in both children and adults.[28][42]​ Azithromycin is the preferred macrolide due to the convenience of single dosing. Erythromycin is used less commonly, but is the recommended drug in pregnancy.[43] Macrolides may cause QT interval prolongation. Use caution in: patients with a history of QT interval prolongation; conditions that may increase the risk of QT prolongation or torsades de pointes; or patients who are on other medications known to prolong the QT interval.

Fluoroquinolones (e.g., ciprofloxacin) are only recommended when it is considered inappropriate to use other antibiotics that are commonly recommended for this infection. Systemic fluoroquinolone antibiotics may cause serious, disabling, and potentially long-lasting or irreversible adverse events. This includes, but is not limited to: tendinopathy/tendon rupture; peripheral neuropathy; arthropathy/arthralgia; aortic aneurysm and dissection; heart valve regurgitation; dysglycaemia; and central nervous system effects including seizures, depression, psychosis, and suicidal thoughts and behaviour.[44]​ Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics, that are commonly recommended for the infection, are inappropriate (e.g., resistance, contraindications, treatment failure, and unavailability). Consult your local guidelines and drug formulary for more information on suitability, contraindications, and precautions.

Research by the Centers for Disease Control and Prevention indicates that antibiotic-resistant strains of Campylobacter have increased. In 2019, 28% of Campylobacter infections were resistant to ciprofloxacin and 4% were resistant to azithromycin, with 2% having decreased susceptibility to both medicines.[45]

In immunocompromised patients, antimicrobial therapy should be chosen based on laboratory sensitivity testing, and prolonged therapy is usually necessary.[46][47]​​

In complicated cases requiring the use of antibiotics, empirical treatment should begin while waiting for sensitivity testing.

With systemic infections, intravenous antibiotics are indicated.

If a patient does not respond to sensitivity-guided antimicrobial therapy, other possible aetiologies should be investigated.

Treatment course: 5 days (erythromycin, ciprofloxacin); 3-5 days (azithromycin).[42][43]

Primary options

azithromycin: children: 10 mg/kg orally once daily, maximum 500 mg/day; adults: 500 mg orally once daily

OR

erythromycin base: children: 30-50 mg/kg/day orally given in 4 divided doses, maximum 2000mg/day; adults: 500 mg orally four times daily

Secondary options

ciprofloxacin: adults: 500-750 mg orally twice daily

Consider – probiotics

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gastroenteritis
Consider – 

probiotics

Additional treatment recommended for SOME patients in selected patient group

Probiotics can be offered to reduce the symptom severity and duration of diarrhoea in immunocompetent adults and children with infectious or antimicrobial-associated diarrhoea.[28] However, additional research is needed to guide the use of probiotics in patients suffering from Campylobacterenteritis.[48] 

Consider – zinc

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ACUTE
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gastroenteritis
Consider – 

zinc

Additional treatment recommended for SOME patients in selected patient group

Oral zinc supplementation has been shown to reduce the duration of infectious diarrhoea in children aged 6 months to 5 years in countries with a high prevalence of zinc deficiency or in children suffering from malnutrition.[28]

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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