TREATMENT Campylobacter Infection
Fluid and electrolyte replacement is central to the treatment of diarrheal illnesses (Chap. 30). Even among patients presenting for medical attention with Campylobacter enteritis, not all clearly benefit from specific antimicrobial therapy. Indications for therapy include high fever, bloody diarrhea, severe diarrhea, persistence for >1 week, and worsening of symptoms. A 5- to 7-day course of erythromycin (250 mg orally four times daily or—for children—30–50 mg/kg per day, in divided doses) is the regimen of choice. Both clinical trials and in vitro susceptibility testing indicate that other macrolides, including azithromycin (a 1- or 3-day regimen), also are useful therapeutic agents. An alternative regimen for adults is ciprofloxacin (500 mg orally twice daily) or another fluoroquinolone for 5–7 days, but resistance to this class of agents as well as to tetracyclines is substantial; ~22% of U.S. isolates in 2010 were resistant to ciprofloxacin. Because macrolide resistance usually is much less common (<10%), these drugs are the empirical agents of choice. Patients infected with antibiotic-resistant strains are at increased risk of adverse outcomes. Use of antimotility agents, which may prolong the duration of symptoms and have been associated with toxic megacolon and with death, is not recommended.
For systemic infections, treatment with gentamicin (1.7 mg/kg IV every 8 h after a loading dose of 2 mg/kg), imipenem (500 mg IV every 6 h), or chloramphenicol (50 mg/kg IV each day in three or four divided doses) should be started empirically, but susceptibility testing should then be performed. Ciprofloxacin and amoxicillin-clavulanate are alternative agents for susceptible strains. In the absence of immunocompromise or endovascular infections, therapy should be administered for 14 days. For immunocompromised patients with systemic infections due to C. fetus and for patients with endovascular infections, prolonged therapy (for up to 4 weeks) is usually necessary. For recurrent infections in immunocompromised hosts, lifelong therapy/prophylaxis is sometimes necessary.