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. [39]
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. [40, 41, 42]
A meta-analysis was done to assess the effects of antibiotic treatment versus placebo on duration of symptoms in patients with Campylobacter infections. [39] 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, [8] and norfloxacin. [8] 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 3-5 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, [43, 44] 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
When given early in gastroenteritis, erythromycin and azithromycin shorten the duration of illness and aid excretion of organisms, as well as preventing relapse.
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.
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Scanning electron microscope image of Campylobacter jejuni, illustrating its corkscrew appearance and bipolar flagella. Source: Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia.
