A 5-year-old boy is brought to the clinic for follow-up of abdominal pain and diarrhea. Four days prior, he was evaluated at the onset of low-grade fever and mucus-filled diarrhea, and a stool culture was obtained. The parents were instructed to increase the patient's fluid intake and return in a few days. Since that time, his fevers have resolved, but he continues to have 5-6 episodes of watery, mucus-filled diarrhea daily. The patient has no chronic medical conditions. Temperature is 37.2 C (99 F) and blood pressure is 98/50 mm Hg. Mucous membranes are moist. Heart and lung examinations are normal. The abdomen is mildly distended and diffusely tender to deep palpation without hepatosplenomegaly or masses. Hemoccult testing is negative. Stool culture reveals a large growth of Campylobacter coli with the following susceptibilities: Which of the following is the most appropriate treatment for this patient's condition?

Question

A 5-year-old boy is brought to the clinic for follow-up of abdominal pain and diarrhea.  Four days prior, he was evaluated at the onset of low-grade fever and mucus-filled diarrhea, and a stool culture was obtained.  The parents were instructed to increase the patient's fluid intake and return in a few days.  Since that time, his fevers have resolved, but he continues to have 5-6 episodes of watery, mucus-filled diarrhea daily.  The patient has no chronic medical conditions.  Temperature is 37.2 C (99 F) and blood pressure is 98/50 mm Hg.  Mucous membranes are moist.  Heart and lung examinations are normal.  The abdomen is mildly distended and diffusely tender to deep palpation without hepatosplenomegaly or masses.  Hemoccult testing is negative.  Stool culture reveals a large growth of Campylobacter coli with the following susceptibilities:  Which of the following is the most appropriate treatment for this patient's condition?

Quizplus · Accepted Answer

11ec25c8_d6b3_631f_bc81_3d3f49625822_MD0003_00 Campylobacter infection (typically C jejuni or C coli) is a foodborne gastrointestinal illness most commonly caused by consumption of undercooked poultry. Infection can also spread via contaminated water or contact with an animal (eg, dog, cat) with Campylobacter diarrhea. Symptoms usually develop around 3 days after exposure and include fever, abdominal pain, and profuse, watery, mucus-filled diarrhea, as seen in this patient. Bloody stools may develop and are more commonly seen in children. Nausea and vomiting are also frequently present. Campylobacter gastroenteritis is generally a self-limited illness. Therefore, treatment is with symptomatic care only (eg, rehydration) for patients with mild disease, such as this patient who is afebrile, well hydrated, and has had nonbloody diarrhea for <7 days. (Choices A, B, C, and D) Antibiotic therapy for Campylobacter gastroenteritis is indicated only in patients with severe disease (eg, duration >7 days, bloody stools, high fevers) or underlying risk factors for severe disease (eg, pregnant, immunocompromised), neither of which are seen in this patient. If this patient's infection were severe, amoxicillin would be the best antibiotic choice based on culture sensitivities. Although the bacteria are sensitive to doxycycline, tetracyclines are generally avoided in children age <8 due to the risk of tooth discoloration. In addition, although azithromycin or levofloxacin is usually used for empiric treatment of severe Campylobacter diarrhea, neither antibiotic would be appropriate for this patient with bacteria resistant to fluoroquinolones and intermediate sensitivity to macrolides. Educational objective: Campylobacter gastroenteritis is most commonly caused by undercooked poultry and presents with fever, abdominal pain, and mucus-filled (sometimes bloody) diarrhea. Disease is typically mild and self-limited, requiring symptomatic care only. References: Global epidemiology of Campylobacter infection. (http://www.ncbi.nlm.nih.gov/pubmed/26062576)

A 5-Year-Old Boy Is Brought to the Clinic for Follow-Up