eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Campylobacter Infections: Treatment & Medication
Updated: Oct 5, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Evaluation of patients with Campylobacter infections can usually be performed on an outpatient basis.
- Intravenous hydration and inpatient care may be necessary for patients who are severely dehydrated and cannot tolerate oral hydration.
Surgical Care
- Occasionally, acute abdominal pain may be the only presenting symptom, often mimicking acute appendicitis and resulting in immediate laparotomy.
Consultations
- Consultation with an infectious disease specialist and a gastroenterologist may be necessary for complicated cases.
Diet
- Because rehydration and electrolyte replacement are the mainstays for treating diarrheal disease, oral rehydration with an electrolyte and glucose solution is necessary.
Activity
- Permit activity as tolerated.
Medication
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.21
C jejuni is usually sensitive to erythromycin, azithromycin, gentamicin, tetracycline, and chloramphenicol. Reports of ciprofloxacin-resistant strains are increasing in most countries.22 A meta-analysis was done to assess the effects of antibiotic treatment versus placebo on duration of symptoms in patients with Campylobacter infections.21 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,23,24 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
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.
Adult
800 mg (EES) PO qid; not to exceed 4 g/d
250-500 mg (base, stearate, or estolate) PO qid; not to exceed 4 g/d
15-20 mg/kg/d IV divided q6h; not to exceed 4 g/d
Pediatric
30-50 mg/kg/d PO divided q6h; not to exceed 2 g/d
20-50 mg/kg/d IV divided q6h; not to exceed 2 g/d
Inhibits CYP450 isoenzymes 1A2 and 3A3/4; decreases clearance of terfenadine, cisapride, and astemizole, which may result in serious cardiac arrhythmias; may also decrease clearance and therefore potentiate carbamazepine, methylprednisolone, cyclosporine, digoxin, hexobarbital, theophylline, warfarin, ergotamine, triazolam, and others; avoid lovastatin; coadministration with lovastatin and simvastatin, increases risk of rhabdomyolysis; decreases metabolism of repaglinide, thus increasing serum levels and effects
Documented hypersensitivity; hepatic impairment; concomitant administration of terfenadine (recalled from US market), cisapride, and astemizole (recalled from US market)
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (administer pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
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.
Adult
Day 1: 500 mg PO
Days 2-5: 250 mg/d PO
Pediatric
<6 months: Not established
>6 months:
Day 1: 10 mg/kg PO once; not to exceed 500 mg/d
Days 2-5: 5 mg/kg/d PO; not to exceed 250 mg/d
May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine
Documented hypersensitivity; hepatic impairment; do not administer with pimozide
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Site reactions can occur with IV route; bacterial or fungal overgrowth may result from prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in hospitalized, geriatric, or debilitated patients
Tetracyclines
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).
Adult
250-500 mg/dose PO q6h; not to exceed 2 g/d
Pediatric
<8 years: Not recommended
>8 years: 25-50 mg/kg/d PO divided q6h; not to exceed 2 g/d
May increase serum digoxin levels; antacids, iron, zinc, calcium, magnesium, dairy products, urinary alkalinizers, and food reduce absorption; avoid concomitant methoxyflurane; monitor prothrombin time with PO anticoagulant
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Renal impairment; monitor blood, renal, and liver function in long-term use; avoid excessive sun or UV light; not recommended for nursing mothers; use of tetracyclines during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of the teeth; never administer outdated tetracyclines; degradation products of tetracyclines are highly nephrotoxic and can cause a Fanconilike syndrome
Lincosamide antibiotics
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.
Adult
150-450 mg/dose PO q6-8h; not to exceed 1.8 g/24h
600-2700 mg/d IM/IV divided q6-12h; not to exceed 4.8 g/24h
Pediatric
20-30 mg/kg/d PO divided q6h
25-40 mg/kg/d IM/IV divided q6-8h
May potentiate neuromuscular blocking agents; may antagonize erythromycin; antiperistaltic agent may worsen colitis
Documented hypersensitivity to preparations containing clindamycin or lincomycin; pseudomembranous colitis; hepatic impairment
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Not for treatment of meningitis; discontinue if colitis occurs and treat; monitor neonates and those with gastrointestinal disease; monitor blood, renal, and hepatic function in long-term use and in children; use with caution in patients with renal or hepatic disease with metabolic aberrations; nursing mothers
Aminoglycoside antibiotics
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.
Adult
1 mg/kg/dose IM/IV q8h or total dose once a day; not to exceed 5 mg/kg/d
Dosing intervals based on CrCl:
>60 mL/min: Administer q8h
40-60 mL/min: Administer q12h
20-40 mL/min: Administer q24h
10-20 mL/min: Administer q48h
<10 mL/min: Administer q72h
Pediatric
Neonates/Infants:
<29 weeks postconception, 0-28 days postnatal:
2.5 mg/kg/dose IM/IV qd
<29 weeks postconception, >28 days postnatal:
3 mg/kg/dose IM/IV qd
30-36 weeks postconception, 0-14 days postnatal:
3 mg/kg/dose IM/IV qd
30-36 weeks postconception, >14 days postnatal:
2.5 mg/kg/dose IM/IV q12h
>37 weeks postconception, 0-7 days postnatal:
2.5 mg/kg/dose IM/IV q12h
>37 weeks postconception, >7 days postnatal:
2.5 mg/kg/dose IM/IV q8h
Children: 2-2.5 mg/kg/dose IM/IV q8h
Avoid concomitant furosemide, ethacrynic acid, other nephrotoxic or neurotoxic drugs including cephalosporins; may potentiate neuromuscular blockade
Documented hypersensitivity to gentamicin or another aminoglycoside
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Monitor for nephrotoxicity and neurotoxicity; avoid peak serum levels >12 mcg/mL and trough levels >2 mcg/mL; for renal impairment, reduce dose, maintain adequate hydration; prolonged use or excessive doses; asthma; neuromuscular disorders
Fluoroquinolone antibiotics
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.
Adult
250-750 mg/dose PO q12h; not to exceed 2 g/d
200-400 mg/dose IV q12h; not to exceed 800 mg/d
Pediatric
Data limited; suggested doses
20-30 mg/kg/d PO divided bid; not to exceed 1.5 g/d
10-20 mg/kg/d IV divided q12h; not to exceed 800 mg/d
May increase theophylline levels; avoid PO forms with antacids, calcium, iron, zinc, and sucralfate; avoid urinary alkalinizers; potentiated by probenecid; interferes with caffeine metabolism; severe hypoglycemia with glyburide (rare); increased serum creatinine level with cyclosporine; monitor PO anticoagulants (potentiation) and phenytoin (variable effects)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Renal (creatinine clearance <29 mL/min) or hepatic dysfunction, reduce dose; discontinue if tendon pain, inflammation, or rupture occur; discontinue if rash, phototoxicity, or other sign of hypersensitivity occurs; may cause CNS or convulsive disorders; maintain hydration, avoid alkaline urine to avoid crystalluria; avoid excessive sun and UV light; not recommended for breastfeeding mothers
Antibiotics, other
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.
Adult
Based on imipenem component, 250-1000 mg/dose IV q6-8h; not to exceed 4 g/d or 50 mg/kg/d
Pediatric
50-100 mg/kg/d IV divided q6-8h; not to exceed 4 g/d
Coadministration with cyclosporine may increase CNS adverse effects of both agents; coadministration with ganciclovir may result in generalized seizures
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Penicillin, cephalosporin, or other allergy; CNS disorders, especially brain lesions or seizures; reduce dose for renal impairment
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.
Adult
50-100 mg/kg/d IV divided q6h; not to exceed 4 g/d
Pediatric
Neonates:
Loading dose: 20 mg/kg IV
Maintenance dose: Administer first maintenance dose 12h after loading dose
<7 days: 25 mg/kg/d IV qd
>7 days:
<2 kg: 25 mg/kg/d IV qd
>2 kg: 50 mg/kg/d IV divided q12h
Infants/children: 50-100 mg/kg/d IV divided q6h; not to exceed 4 g/d
Avoid other agents that cause bone marrow depression; may increase effects of hydantoins or sulfonylureas; may increase serum iron levels, decrease response to iron, vitamin B-12
When administered concurrently with barbiturates, chloramphenicol serum levels may decrease and barbiturate levels may increase, causing toxicity; rifampin may reduce serum chloramphenicol levels, presumably through hepatic enzyme induction; may increase effects of anticoagulants
Trivial infections or prophylaxis; previous toxic reactions to chloramphenicol; G-6-PD deficiency
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in pregnancy at term or during labor because of potential toxic effects on fetus (gray baby syndrome)
Perform blood tests at baseline and q2d during therapy; discontinue if blood dyscrasias, optic neuritis, or peripheral neuritis develops; avoid repeat therapy; monitor serum levels; breastfeeding women
Ceftriaxone (Rocephin)
Third-generation cephalosporin. Arrests bacterial growth by binding to one or more penicillin-binding proteins.
Adult
1-4 g/d IV divided q12-24h; not to exceed 4 g/d
Pediatric
Infants and children: 50-75 mg/kg/d IM/IV divided q12-24h
Meningitis: 100 mg/kg/d IV/IM divided q12-24h; not to exceed 4 g/d
May cause false-positive Clinitest results; potentiated by probenecid
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Penicillin or other allergy; concomitant renal and hepatic impairment, (not to exceed 2 g/d); chronic hepatic disease or malnutrition, monitor prothrombin time; GI disease
Ampicillin (Marcillin, Omnipen)
Broad-spectrum penicillin. Bactericidal activity against susceptible organisms.
Adult
500-3000 mg IV q4-6h; not to exceed 12 g/d IV
Pediatric
Neonates <7 days:
<2 kg: 50-100 mg/kg/d IV divided q12h
>2 kg: 75-150 mg/kg/d IV divided q8h
Neonates >7 days:
<1.2 kg: 50-100 mg/kg/d IV divided q12h
1.2-2 kg: 75-150 mg/kg/d IV divided q8h
>2 kg: 100-200 mg/kg/d IV divided q6h
Children:
Mild-to-moderate infections: 100-200 mg/kg/d IV divided q6h
Severe infections: 200-400 mg/kg/d IV divided q4-6h
May cause false-positive Clinitest result; potentiated by probenecid
Documented hypersensitivity; contraindicated in infections caused by penicillinase-producing organism
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May have cross-sensitivity with cephalosporins or imipenem; high incidence of rash with mononucleosis; monitor blood, renal, and liver function with long-term use
More on Campylobacter Infections |
| Overview: Campylobacter Infections |
| Differential Diagnoses & Workup: Campylobacter Infections |
 Treatment & Medication: Campylobacter Infections |
| Follow-up: Campylobacter Infections |
| Multimedia: Campylobacter Infections |
| References |
| « Previous Page | Next Page » |
References
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Further Reading
Keywords
Campylobacter infections, campylobacteriosis, Campylobacteraceae, Campylobacter, Campylobacter jejuni, C jejuni, Campylobacter fetus, C fetus, Arcobacter, C jejuni subspecies doylei, Campylobacter coli, Campylobacter upsaliensis, Campylobacter Lari, C fetus subspecies fetus, Campylobacter hyointestinalis, Campylobacter concisus, Campylobacter sputorum, Campylobacter curvus, Campylobacter rectus, Campylobacter pylori, Helicobacter pylori, meningitis, cholecystitis , urinary tract infection, mesenteric adenitis, bacteremia, gravid uterus, enteritis, arthritis, pancreatitis, osteomyelitis
