Introduction

Diarrhoea and tummy pain following a summer barbeque - could this be campylobacter gastroenteritis? Campylobacter is a bacteria that can cause stomach and intestinal infection and is commonly associated with undercooked poultry or raw milk.¹ However, the best treatment for this condition is still under debate – should we treat it with antibiotics or just leave it to run its course? 

Understanding campylobacter infections

Definition and causes

Campylobacter is a bacteria that causes gastroenteritis- or inflammation of the stomach and intestines in humans. The bacteria spreads through oral routes, commonly by ingesting contaminated food. 

The bacteria is commonly found in nature and domestic animals. The most common causes of campylobacter infection in humans are: 

• Raw or undercooked poultry 
• Contaminated drinking water 
• Unpasteurised milk 

Risk factors and prevalence

Campylobacter is the most common cause of bacterial gastroenteritis in the UK. In 2019, the prevalence in England was roughly 1 in 1000.² The prevalence of the bug tends to be higher in late spring and early summer. It affects people of all ages. 

Common risk factors³

• Immunosuppression, e.g. HIV, cancer 
• Previous abdominal surgery 
• Poor hand hygiene 
• Travelling to developing countries and drinking contaminated water 
• Working with farm animals 

Clinical presentation and complications

The disease gastroenteritis by campylobacter infection can vary in presentation and severity. 

Typical symptoms which occur are:⁴ 

• ‘Flu-like’ symptoms – fever, headache, muscle aches. These typically last between 2 -5 days
• Diarrhoea – often continues bloody, up to 10 motions per day 
• Abdominal pain 
• Tummy cramps 
• Ongoing fever 

The condition is identified by testing a stool sample sent to a laboratory. 

Unfortunately, even once the main symptoms have passed, there may be some longer-term complications of campylobacter infection. More common complications include dehydration or sepsis – a widespread bloodborne infection which affects multiple organs in the body. Another complication is reactive arthritis, whereby a person has longer-term joint pains following the resolution of the infection. Some cases develop Guillain-Barre Syndrome, a condition in which the nerves of the body are damaged (sometimes permanently) and cause progressive weakness in your muscles. 

There are other conditions which mimic these symptoms, such as appendicitis – so it is important to seek medical advice if you display this collection of symptoms. 

Treatment options 

The treatment of campylobacter infections is contentious. Some people favour antibiotics to treat bacterial infections. However, other people argue the best treatment is to let the infection run its course and manage any symptoms. They would argue that antibiotics do not reduce the duration of illness. 

We will look through both treatment options in further detail. 

Antibiotic treatment options 

Indications for antibiotic use 

In many cases, antibiotic therapy has been shown to have a limited effect on the duration of symptoms for campylobacter infections.⁵ As such, they are reserved for high-risk patients or those with clinical complications. 

Examples of high-risk patients: 

• Immunosuppressed or history of HIV 
• Pregnancy 
• Severe symptoms – high fever, bloody diarrhoea 
• Failure of symptoms improve with supportive measures

Common antibiotic therapy

Therapy for campylobacter tends to be with macrolide antibiotics. These are a family of medications that include antibiotics such as clarithromycin, erythromycin, and tetracycline. Another type of antibiotic sometimes used is ciprofloxacin. These antibiotics are given for 7 – 14 days. 

Issues relating to antibiotic use 

Unfortunately, macrolide antibiotics will have some side effects, as with many antibiotics. Common side effects include muscle weakness, altered heart rhythms and yellowing of the skin. As such, we mustn't use antibiotics when they are unnecessary. 

Another issue is antibiotic resistance.⁶ This is where bacteria develop defences against the commonly used antibiotics and are no longer destroyed by them. As these bacteria survive, they replicate and become more common in humans. This poses a big problem to scientists as many antibiotic-resistant bacteria increase. The risk of antibiotic resistance increases when patients do not complete the prescribed course of antibiotics. 

Supportive care 

The treatment for campylobacter infection can often be supportive – meaning that we let the infection run its course and simply manage the symptoms a person may experience. 

In cases of severe diarrhoea, fluid losses can result in dehydration. Therefore, it is important to continue drinking fluids during the illness. Oral rehydration salts can also be used to replenish important salts which may be lost. In more severe cases, a person may require hospitalisation for intravenous fluids. 

Regular pain management, such as paracetamol, can be used to manage abdominal pain. Furthermore, paracetamol will also help manage high temperatures experienced during illness. 

Anti-motility medications such as loperamide should not be used. Although this may seem counterintuitive as they may slow bowel motions, they can cause worsening of symptoms and prolong the course of the illness. 

Preventive and long-term measures 

Some measures can be taken to reduce the risk of contracting campylobacter infection. 

The bacteria is contagious between people. This means someone can become infected by touching a contaminated surface and then touching their mouth. Therefore, regular hand hygiene and disinfection when contacting someone with confirmed campylobacter is essential. People should also remain off school/work until their diarrhoea settles. 

As we have discussed, campylobacter can also spread through undercooked food. It is important to keep this in mind when cooking and to follow food safety guidelines closely. Examples of good practice are to ensure poultry is well cooked before consumption. Unpasteurised milk is a leading cause of campylobacter. It is, therefore, important to carefully read labels and ensure dairy products are ‘pasteurised’ and thus safe to consume. 

Finally, whilst travelling in developing countries, extra precautions should be taken. This includes drinking bottled water if tap water is unsafe to drink. Caution should also be taken with salads, drinks or ice cubes that may have been prepared using contaminated water. 

Conclusion

The treatment of campylobacter infections remains complicated. In most cases, symptoms will be minimal and supportive management will be enough – ensuring you get enough fluids and manage any pain with paracetamol. However, antibiotics may be indicated in select cases to further fight off the infection.