Pediatric Campylobacter Infections Medication
- Author: Jocelyn Y Ang, MD; Chief Editor: Russell W Steele, MD more...
Medication Summary
Most C jejuni infections are generally mild and self-limited. The need to administer antimicrobials in uncomplicated cases is still controversial. Correction of electrolyte abnormalities and rehydration are the mainstay of treatment for enteritis due to Campylobacter species. Antimicrobial therapy should be considered in immunocompromised hosts or in individuals with fever, increasing bloody diarrhea, or symptoms that last longer than 1 week.[23]
C jejuni is usually sensitive to erythromycin, azithromycin, gentamicin, tetracycline, and chloramphenicol. Reports of antimicrobial resistant strains, including those resistant to ciprofloxacin and doxycycline, are increasing in most countries.[24, 25, 26]
A meta-analysis was done to assess the effects of antibiotic treatment versus placebo on duration of symptoms in patients with Campylobacter infections.[23] This study included 11 randomized controlled trials with a total of 479 patients. Ninety one of 479 were pediatric patients and accounted for 19% of the participants. Antibiotics tested included erythromycin (6 trials), ciprofloxacin,[3] and norfloxacin.[3] This meta-analysis showed a decrease in duration of symptoms by 1.3 days with antibiotic treatment compared with placebo. Antibiotic treatment also decreases the duration of fecal shedding. In addition, antibiotics were beneficial if initiated within the first 3 days of illness, with a mean decrease of symptoms of 0.35 days of earlier treatment.
The recommended duration for antibiotic treatment for gastroenteritis is 5-7 days. Antimicrobial therapy for all immunocompromised patients with C jejuni bacteremia should be selected based on a laboratory susceptibility test. Begin therapy with gentamicin, imipenem, third-generation cephalosporins, or chloramphenicol until susceptibility test results are available.
Because infections with C fetus are usually systemic, intravenous antibiotics are usually required. Aminoglycosides, such as gentamicin and carbapenem, are usually used for empiric treatment. Based on in vitro susceptibility test results,[27, 28] alternatives for C fetus bacteremia include ampicillin, chloramphenicol, and third-generation cephalosporins. Duration of therapy is empiric. Patients with CNS infection require treatment for 2-3 weeks with a third-generation cephalosporin, ampicillin, or chloramphenicol Those with endovascular infection should be treated for at least 4 weeks with gentamicin as the drug of choice (DOC). Treatment with ampicillin or third-generation cephalosporins are other alternatives. Erythromycin is the DOC in patients with diarrheal illness secondary to C fetus infection.
Macrolide antibiotics
Class Summary
Ease of administration, lack of serious adverse effects, and fewer propensities to select for plasmid-mediated antibiotic resistance make erythromycin the DOC.
Erythromycin (E.E.S., E-Mycin, Eryc, Ery-Tab)
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest.
In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.
Azithromycin (Zithromax)
Acts by binding to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected. Concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues. Treats mild-to-moderate microbial infections.
Plasma concentrations are very low, but tissue concentrations are much higher, giving it value in treating intracellular organisms. Has a long tissue half-life. Single dose is recommended.
May become DOC because of safety profile, ease of use, and improved GI tract tolerability relative to erythromycin. Administer caps and PO susp on an empty stomach, at least 1 h before or 2 h after meals. Tab and PO powder (sachet) may be administered with food.
Tetracyclines
Class Summary
These agents may be used in children but are not approved for children younger than 9 years because of the risk of dental staining.
Tetracycline (Sumycin)
Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).
Lincosamide antibiotics
Class Summary
These drugs represent an alternative to tetracycline.
Clindamycin (Cleocin)
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Aminoglycoside antibiotics
Class Summary
Reserve these drugs for treatment of infections caused by organisms not sensitive to less toxic agents.
Gentamicin (Garamycin, Pediatric Gentamicin Sulfate)
Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes.
Fluoroquinolone antibiotics
Class Summary
Ciprofloxacin and other fluoroquinolones are alternative agents to erythromycin but are not approved for those younger than 18 years.
Ciprofloxacin (Cipro)
Inhibits bacterial DNA synthesis and, consequently, growth. Continue treatment for at least 2 d after signs and symptoms have disappeared.
Antibiotics, other
Class Summary
Alternatives for C fetus bacteremia include ampicillin, imipenem, chloramphenicol, and third-generation cephalosporins. Reported synergistic combinations include ampicillin with gentamicin and imipenem with gentamicin. Duration of therapy is empiric.
Imipenem and cilastatin sodium (Primaxin)
Carbapenem antibiotic. For treatment of multiple organism infections in which other agents do not have wide-spectrum coverage or are contraindicated due to potential for toxicity.
Chloramphenicol (Chloromycetin)
Binds to 50 S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria.
Ceftriaxone (Rocephin)
Third-generation cephalosporin. Arrests bacterial growth by binding to one or more penicillin-binding proteins.
Ampicillin (Marcillin, Omnipen)
Broad-spectrum penicillin. Bactericidal activity against susceptible organisms.
Zilbauer M, Dorrell N, Wren BW, Bajaj-Elliott M. Campylobacter jejuni-mediated disease pathogenesis: an update. Trans R Soc Trop Med Hyg. Feb 2008;102(2):123-9. [Medline].
Allos BM. Campylobacter jejuni Infections: update on emerging issues and trends. Clin Infect Dis. Apr 15 2001;32(8):1201-6. [Medline].
CDC. Vital signs: incidence and trends of infection with pathogens transmitted commonly through food--foodborne diseases active surveillance network, 10 U.S. sites, 1996-2010. MMWR Morb Mortal Wkly Rep. Jun 10 2011;60(22):749-55. [Medline].
Feierl G, Jelovcan S. Campylobacteriosis in Austria: situation and trends. Wien Klin Wochenschr. 2009;121(3-4):103-7. [Medline].
Jafari F, Garcia-Gil LJ, Salmanzadeh-Ahrabi S, Shokrzadeh L, Aslani MM, Pourhoseingholi MA. Diagnosis and prevalence of enteropathogenic bacteria in children less than 5 years of age with acute diarrhea in Tehran children's hospitals. J Infect. Jan 2009;58(1):21-7. [Medline].
Wang SC, Chang LY, Hsueh PR, et al. Campylobacter enteritis in children in northern Taiwan--a 7-year experience. J Microbiol Immunol Infect. 2008;41(5):408-413.
Soofi SB, Habib MA, von Seidlein L, et al. A comparison of disease caused by Shigella and Campylobacter species: 24 months community based surveillance in 4 slums of Karachi, Pakistan. J Infect Public Health. Mar 2011;4(1):12-21. [Medline].
Yang JR, Wu HS, Chiang CS, Mu JJ. Pediatric campylobacteriosis in northern Taiwan from 2003 to 2005. BMC Infect Dis. 2008;8:151. [Medline].
Gillespie IA, O'Brien SJ, Penman C, Tompkins D, Cowden J, Humphrey TJ. Demographic determinants for Campylobacter infection in England and Wales: implications for future epidemiological studies. Epidemiol Infect. Dec 2008;136(12):1717-25. [Medline].
Samuel MC, Vugia DJ, Shallow S, et al. Epidemiology of sporadic Campylobacter infection in the United States and declining trend in incidence, FoodNet 1996-1999. Clin Infect Dis. 2004;38 Suppl 3:S165-174.
Coker AO, Isokpehi RD, Thomas BN, Amisu KO, Obi CL. Human campylobacteriosis in developing countries. Emerg Infect Dis. Mar 2002;8(3):237-44. [Medline].
Sorokin M, Usein CR, Irimia M, Damian M. A laboratory-based survey of Campylobacter infections in Prahova County. Roum Arch Microbiol Immunol. Jul-Dec 2007;66(3-4):85-9. [Medline].
Pacanowski J, Lalande V, Lacombe K, Boudraa C, Lesprit P, Legrand P. Campylobacter bacteremia: clinical features and factors associated with fatal outcome. Clin Infect Dis. Sep 15 2008;47(6):790-6. [Medline].
Tee W, Mijch A. Campylobacter jejuni bacteremia in human immunodeficiency virus (HIV)-infected and non-HIV-infected patients: comparison of clinical features and review. Clin Infect Dis. Jan 1998;26(1):91-6. [Medline].
Blaser MJ. Extraintestinal Campylobacter infections. West J Med. Mar 1986;144(3):353-4. [Medline].
Uzoigwe C. Campylobacter infections of the pericardium and myocardium. Clin Microbiol Infect. Apr 2005;11(4):253-5. [Medline].
Fujihara N, Takakura S, Saito T, Iinuma Y, Ichiyama S. A case of perinatal sepsis by Campylobacter fetus subsp. fetus infection successfully treated with carbapenem--case report and literature review. J Infect. 2006;53(5):e199-202.
Simor AE, Karmali MA, Jadavji T, Roscoe M. Abortion and perinatal sepsis associated with campylobacter infection. Rev Infect Dis. May-Jun 1986;8(3):397-402. [Medline].
Krishnaswamy R, Sasidharan P, Rejjal A, Osba YA. Early onset neonatal sepsis with Campylobacter jejuni: a case report. Eur J Pediatr. Feb 1991;150(4):277-8. [Medline].
Gazaigne L, Legrand P, Renaud B, Bourra B, Taillandier E, Brun-Buisson C. Campylobacter fetus bloodstream infection: risk factors and clinical features. Eur J Clin Microbiol Infect Dis. Mar 2008;27(3):185-9. [Medline].
Bessede E, Delcamp A, Sifre E, et al. New methods for detection of campylobacters in stool samples in comparison to culture. J Clin Microbiol. Mar 2011;49(3):941-4. [Medline].
Mee AS, Shield M, Burke M. Campylobacter colitis: differentiation from acute inflammatory bowel disease. J R Soc Med. Mar 1985;78(3):217-23. [Medline].
Ternhag A, Asikainen T, Giesecke J, Ekdahl K. A meta-analysis on the effects of antibiotic treatment on duration of symptoms caused by infection with Campylobacter species. Clin Infect Dis. Mar 1 2007;44(5):696-700. [Medline].
Alfredson DA, Korolik V. Antibiotic resistance and resistance mechanisms in Campylobacter jejuni and Campylobacter coli. FEMS Microbiol Lett. Dec 2007;277(2):123-32. [Medline].
Valenza G, Frosch M, Abele-Horn M. Antimicrobial susceptibility of clinical Campylobacter isolates collected at a German university hospital during the period 2006-2008. Scand J Infect Dis. 2010;42(1):57-60. [Medline].
Ewnetu D, Mihret A. Prevalence and antimicrobial resistance of Campylobacter isolates from humans and chickens in Bahir Dar, Ethiopia. Foodborne Pathog Dis. Jun 2010;7(6):667-70. [Medline].
Tremblay C, Gaudreau C. Antimicrobial susceptibility testing of 59 strains of Campylobacter fetus subsp. fetus. Antimicrob Agents Chemother. Jul 1998;42(7):1847-9. [Medline].
Tremblay C, Gaudreau C, Lorange M. Epidemiology and antimicrobial susceptibilities of 111 Campylobacter fetus subsp. fetus strains isolated in Quebec, Canada, from 1983 to 2000. J Clin Microbiol. Jan 2003;41(1):463-6. [Medline].
Yuki N. Campylobacter sialyltransferase gene polymorphism directs clinical features of Guillain-Barré syndrome. J Neurochem. Nov 2007;103 Suppl 1:150-8. [Medline].
McKhann GM, Cornblath DR, Griffin JW, Ho TW, Li CY, Jiang Z. Acute motor axonal neuropathy: a frequent cause of acute flaccid paralysis in China. Ann Neurol. Apr 1993;33(4):333-42. [Medline].
Pope JE, Krizova A, Garg AX, Thiessen-Philbrook H, Ouimet JM. Campylobacter reactive arthritis: a systematic review. Semin Arthritis Rheum. Aug 2007;37(1):48-55. [Medline].
Peterson MC. Rheumatic manifestations of Campylobacter jejuni and C. fetus infections in adults. Scand J Rheumatol. 1994;23(4):167-70. [Medline].
Hannu T, Mattila L, Rautelin H, Pelkonen P, Lahdenne P, Siitonen A. Campylobacter-triggered reactive arthritis: a population-based study. Rheumatology (Oxford). Mar 2002;41(3):312-8. [Medline].
Blaser MJ, Perez GP, Smith PF, Patton C, Tenover FC, Lastovica AJ. Extraintestinal Campylobacter jejuni and Campylobacter coli infections: host factors and strain characteristics. J Infect Dis. Mar 1986;153(3):552-9. [Medline].
Braun KP, Theissig F, Ernst H, May M, Krulls-Munch J. [Campylobacter-jejuni-associated hepatitis and myocardial injury]. Med Klin (Munich). May 15 2008;103(5):346-8. [Medline].
[Guideline] Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals. MMWR Recomm Rep. Apr 16 2004;53:1-33. [Medline].
Godschalk PC, Kuijf ML, Li J, St et al. Structural characterization of Campylobacter jejuni lipooligosaccharide outer cores associated with Guillain-Barre and Miller Fisher syndromes. Infect Immun. 2007;75(3):1245-1254.
Luquero Alcalde FJ, Sanchez Padilla E, Eiros Bouza JM, et al. [Trend and seasonal variations of Campylobacter gastroenteritis in Valladolid, Spain. A five-year series, 2000-2004]. Rev Esp Salud Publica. 2007;81(3):319-326.
Peterson MC. Clinical aspects of Campylobacter jejuni infections in adults. West J Med. Aug 1994;161(2):148-52. [Medline].
Roan JN, Ko WC, Luo CY. Abdominal septic aortic pseudoaneurysm caused by Campylobacter jejuni infection: report of a case. Surg Today. 2009;39(2):137-40. [Medline].
Tokuda K, Nishi J, Miyanohara H, Sarantuya J, Iwashita M, Kamenosono A. Relapsing cellulitis associated with Campylobacter coli bacteremia in an agammaglobulinemic patient. Pediatr Infect Dis J. Jun 2004;23(6):577-9. [Medline].
Print
