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Sections Campylobacter Infections
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Medication

Medication Summary

Azithromycin therapy would be a primary antibiotic choice for Campylobacter jejeni gastroenteritis when indicated (see Medical Care),^[36]with a typical regimen of 500 mg/d for 3 days. However, erythromycin is the classic antibiotic of choice. Its resistance remains low,^[37]and it can be used in pregnant patients and children. Self-limited diarrhea in a normal host may not need treatment.

Macrolides should not be used to treat serious infections (meningitis, bacteremia, and endovascular infections) caused by C fetus.

The use of fluoroquinolones in food animals has resulted in fluoroquinolone-resistant Campylobacter strains worldwide.^{[38, 39]}Quinolone resistance of C jejuni and Campylobacter coli is conferred by the mutation gyrA C-257-T, which can be identified with methods such as multiplex PCR.^[40] A 2008 study from the United Kingdom found fluoroquinolone-resistant Campylobacter species in 22% of poultry and 75% of pig farms.^[41]High levels of ciprofloxacin resistance also have been reported in developing countries, with resistance ranging from 30% to greater than 70%.^{[42, 43]}Some evidence has shown that multidrug resistance in pediatric patients in developing countries may be related to the food chain.^[44]Consequently, their use as empiric therapy should be avoided.

Infections involving macrolide resistance could be treated with amoxicillin-clavulanate.^[45]

Specific antibiotic doses to treat Campylobacter infections have not been fully defined for tetracycline; therefore, the doses below are empirical. Tetracyclines should be avoided in pregnancy and children.

Antibiotic treatment does not prolong carriage of C jejuni.^[46]

CNS infections can be treated with meropenem in meningitis doses for 4 to 6 weeks of prolonged therapy.^{[47, 48, 49]} Life-threatening infections can be treated with carbapenems.

Class Summary

Therapy must be comprehensive and cover all likely pathogens in the context of the clinical setting.

Azithromycin (Zithromax)

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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.

Effective against a wide range of organisms, including the most common gram-positive and gram-negative organisms. Has additional coverage of so-called atypical infections such as Chlamydia, Mycoplasma, and Legionella species.

Indicated for treatment of patients with mild-to-moderate infections, including acute bronchitic infections that may be observed with bronchiectasis.

Erythromycin (E-Mycin, Ery-Tab, E.E.S.)

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DOC for Campylobacter infections. Macrolide antibiotic that inhibits bacterial growth by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For C jejuni (not C fetus) infections.

Doxycycline (Bio-Tab, Doryx, Vibramycin, Doxy, Vibra-Tabs)

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Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. For C jejuni (not C fetus) infections.

Imipenem and cilastatin (Primaxin)

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For treatment of multiple organism infections in which other agents do not have wide-spectrum coverage or are contraindicated because of potential for toxicity. For C fetus (not C jejuni) infection.

Gentamicin (Garamycin, Gentacidin)

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Aminoglycoside antibiotic. May be needed in severe infections. Dosing regimens are numerous; adjust dose based on CrCl and changes in volume of distribution. Can be used for C fetus infections. May be administered IV/IM.

Meropenem (Merrem IV)

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Inhibits cell-wall synthesis by binding to penicillin-binding proteins; resistant to most beta-lactamases. Can be used for C fetus meningitis.

Ampicillin (Ampi, Omnipen, Penglobe)

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Broad-spectrum penicillin; interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms; alternative to amoxicillin when unable to take medication orally.

Amoxicillin/clavulanate (Augmentin, Augmentin ES-600, Augmentin XR)

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Amoxicillin binds to penicillin-binding proteins, thus inhibiting final transpeptidation step of peptidoglycan synthesis in bacterial cell walls; addition of clavulanate inhibits beta-lactamase-producing bacteria, allowing amoxicillin extended spectrum of action.

It is a semisynthetic antibiotic with a broad spectrum of bactericidal activity, covering both gram-negative and gram-positive microorganisms.

Ciprofloxacin (Cipro)

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Synthetic, broad-spectrum antibacterial compounds. Novel mechanism of action, targeting bacterial topoisomerases II and IV, leads to a sudden cessation of DNA replication. Oral bioavailability is nearly 100%. For C jejuni (not C fetus) infections.

Levofloxacin (Levaquin)

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For pseudomonal infections and infections due to multidrug resistant gram-negative organisms. For C jejuni (not for C fetus) infections.

Follow-up

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Media Gallery

Scanning electron microscope image of Campylobacter jejuni, illustrating its corkscrew appearance and bipolar flagella. Source: Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia.

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Author

Mahmud H Javid, MBBS Consultant in Infectious Diseases, Quaid-e-Azam International Hospital, Pakistan

Mahmud H Javid, MBBS is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS Professor of Clinical Medicine, Renaissance School of Medicine at Stony Brook University Medical Center; Adjunct Clinical Associate Professor, Department of Medicine, New York College of Osteopathic Medicine of New York Institute of Technology; Chief, Division of Infectious Diseases, Department of Medicine, Nassau University Medical Center

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Chief Editor