Approach
As with all diarrheal illnesses, fluid and electrolyte replacement is essential to treatment. Even in those patients requiring medical attention for Campylobacter enteritis, only a small proportion are likely to benefit from antimicrobial therapy.
Rehydration
The most common complication of diarrheal illnesses is dehydration. Initial treatment in every patient with Campylobacter infection 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 that polymer-based ORS had advantages over glucose-based ORS, but the analysis was underpowered.[42] For those unable to tolerate oral fluids due to nausea and vomiting, intravenous fluids should be administered and the electrolyte balance monitored closely.
Antimicrobial therapy
Antibiotics are not indicated in uncomplicated infections.[14][43] Indications for antimicrobial therapy include high fever, systemic infection with suspected or sustained bacteremia, grossly bloody diarrhea, 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][41] Azithromycin is the preferred macrolide due to the convenience of single dosing. Erythromycin is used less commonly.[44]
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; dysglycemia; and central nervous system effects including seizures, depression, psychosis, and suicidal thoughts and behavior.[45]
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 medications.[46]
In immunocompromised patients, antimicrobial therapy should be chosen based on laboratory sensitivity testing, and prolonged therapy is usually necessary.[47][48] In complicated cases requiring the use of antibiotics, empiric 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 etiologies should be investigated.
Pregnancy
Campylobacter species can cause perinatal infections and even fetal death. For this reason, Campylobacterinfection should also be actively ruled out in pregnant patients with a diarrheal illness. Erythromycin is the recommended drug in pregnancy.
Probiotics
Probiotics can be offered to reduce the symptom severity and duration of diarrhea in immunocompetent adults and children with infectious or antimicrobial-associated diarrhea.[28] However, additional research is needed to guide the use of probiotics in patients suffering from Campylobacter enteritis.[49]
Zinc
Oral zinc supplementation has been shown to reduce the duration of infectious diarrhea in children ages 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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