Clinical context (Usually self-limited in immunocompetent children · invasive disease and bacteremia in infants and immunocompromised hosts)
First-line therapy
Azithromycin • p.o. • 10–10 mg/kg/day • 1×/day
Max 500 mg/day · Duration: 3 days · Start within 48–72 h of symptom onset for maximal benefit — extend to 5–7 days if severe or immunocompromised
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Erythromycin • p.o. • 10–12.5 mg/kg/dose • 4×/day
Max 500 mg/dose · Max 2000 mg/day · Duration: 5 days · 40 mg/kg/day total in 4 divided doses (AAP) — macrolide alternative
• Erythromycin: azithromycin unavailable, intolerance, or local macrolide susceptibility favors erythromycin — equivalent total daily dose 40 mg/kg/day in 4 divided doses (AAP Red Book).
• Do not use beta-lactams (penicillins, cephalosporins) or trimethoprim-sulfamethoxazole — Campylobacter is inherently resistant (AAP, ESPID).
• Fluoroquinolones (e.g. ciprofloxacin): only if susceptible on culture and macrolides unsuitable — rising resistance limits empiric use (ESPID, CDC).
• Severe invasive disease or inability to take oral therapy: consider i.v. azithromycin or carbapenem per susceptibility and local protocol — complete susceptibility testing (AAP).
• Exclude from child-care while symptomatic; use contact precautions in institutional outbreaks (AAP, CDC).
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Clinical notes
• Antibiotics are not recommended for uncomplicated Campylobacter enteritis in otherwise healthy children — illness is usually mild and self-limited (ESPGHAN, AAP, NICE, WHO).
• Treat with antibiotics when severe disease (high fever, bloody stools, toxic appearance), immunocompromise, neonates, bacteremia, prolonged symptoms (>7 days), or need to limit transmission in high-risk settings (ESPGHAN, SEIP, AAP).
• Antibiotics shorten symptoms only if started early — ESPGHAN: within 48 h of onset; benefit greatest within first 3 days (ESPGHAN Rec. 23, ESPID, AAP).
• Stool culture or PCR when diagnosis is uncertain, severe disease, outbreak investigation, or before antibiotics in non-urgent cases — tailor therapy to susceptibility (CDC, SEIP).
• Supportive care and low-osmolarity oral rehydration remain the mainstay for all patients; continue feeding; avoid anti-motility agents in bloody diarrhea (ESPGHAN, WHO, NICE).
• ESPGHAN / NASPGHAN — Universal recommendations for management of acute diarrhea (2018)
• ESPGHAN / ESPID — Evidence-based guidelines for management of acute gastroenteritis (2014)
