Treatment for Campylobacter Infection
Infection with Campylobacter is typically self-limiting and mild, lasting for several days up to two weeks. Even though antimicrobial treatment may reduce the duration of campylobacteriosis by 1-2 days, antibiotics are not appropriate in general to mitigate the symptoms. One major reason is that the worldwide C. jejuni strain is showing increasing resistance to macrolide and fluoroquinolone antibiotics, which may lead to reduced effectiveness when needed as first-line and second-line options for the treatment of particularly severe systemic diseases over time.
The focus of interventions in healthy patients is hydration and electrolyte repletion. Hydration may be oral or parenteral (i.e., intravenous fluids) depending on the severity of illness and degree of dehydration. Avoidance of anti-motility agents is desirable, as they can delay the resolution of the infection.
Although antibiotics are not recommended for otherwise healthy patients, treatment of campylobacteriosis is recommended in patients with severe disease, which includes those with bloody stools, high fever, extraintestinal infection, worsening or relapsing symptoms, or prolonged symptoms that exceed 1 week. It is also recommended for patients with uncomplicated infection who are elderly, pregnant, or immunocompromised, due to their risk of severe disease.
The use of fluoroquinolone antibiotics has led to the development of resistance, and a 75-90% prevalence of fluoroquinolone resistance has been reported in clinical Campylobacter strains in different countries. Thus, macrolides are now the first-line treatment of human campylobacteriosis. Antibiotic use in farm animals is believed to be the source of resistant strains. Campylobacter strains in Canada previously showed an 8.6% resistance to tetracyclines in 1981; this has increased to 56% in more recent studies. While in the early 1990s there was almost no fluoroquinolone resistance described in the literature, more recent data in the United States shows 40% fluoroquinolone resistance at one site in the Pennsylvania region.
While resistance to macrolide antibiotics has remained low at 1% to 3% in the United States, there is a concern of the eventual development of resistant strains. Patients failing antibiotics therapy require drug susceptibility testing. The current recommended treatment is an oral antibiotic, predominantly a 3-5 day course of a macrolide antibiotic such as azithromycin.