Evaluating Early Macrolide Therapy in Pediatric Campylobacter Enterocolitis: A Comparative Study

Background/Objectives: Azithromycin is widely recommended as the first-line treatment for pediatric Campylobacter enterocolitis, although supporting evidence is limited and there is a lack of studies evaluating the efficacy of other macrolide antibiotics. This study aims to assess the effectiveness of starting macrolide therapy within three days of symptom onset in pediatric patients with Campylobacter enterocolitis. Methods: Pediatric patients under 19 years of age with a new diagnosis of Campylobacter enterocolitis were enrolled and randomly assigned to receive macrolide antibiotic treatment with either azithromycin or clarithromycin in a 1:1 ratio. Additionally, a retrospective historical cohort of pediatric patients diagnosed with Campylobacter enterocolitis prior to the study period, who did not receive macrolide antibiotics, was retrospectively reviewed for comparison. This dual approach allowed for the evaluation of macrolide therapy's effectiveness against untreated cases. Results: The study included 27 patients in the macrolide group and 37 patients in the non-macrolide group. Baseline demographic and clinical characteristics were comparable between groups. Early macrolide therapy was associated with reduced hospital stay (3.8 ± 0.7 vs. 4.5 ± 0.9 days), shorter duration of diarrhea (1.8 ± 1.2 vs. 3.4 ± 0.7 days, p < 0.001), and shorter duration of fever (1.1 ± 0.6 vs. 2.8 ± 1.0 days, p < 0.001). No significant difference was observed in the duration of vomiting (p = 0.061). Conclusions: Early initiation of macrolide antibiotics in children with Campylobacter enterocolitis significantly accelerated complete clinical resolution and shortened hospitalization, particularly by hastening the resolution of diarrhea, fever, and abdominal pain. These findings support the use of early macrolide therapy for pediatric Campylobacter enterocolitis.