Successful treatment by meropenem of Campylobacter jejuni meningitis in a chronic alcoholic following neurosurgery

Meningitis caused by Campylobacter jejuni is rare, we describe a case following neurosurgery for intra-cranial haematoma in a chronic alcoholic patient. Conventional culture of CSF and blood was supplemented by polymerase chain reaction (PCR) detection of Campylobacter jejuni.

Pyogenic vertebral osteomyelitis caused by Campylobacter fetus subspecies fetus. A case report

STUDY DESIGN

Clinical observation of a patient.

OBJECTIVES

To present the clinical features of an unusual infection of the spine caused by Campylobacter fetus subspecies fetus and to suggest treatment.

SUMMARY OF BACKGROUND DATA

This is only the second reported case of pyogenic vertebral osteomyelitis caused by Campylobacter fetus subspecies fetus.

METHODS

A 66-year-old man had pain of the left lower extremity. Radiologic examination revealed an epidural mass associated with destruction of the L5-S1 vertebral bodies.

RESULTS

Biopsy of the epidural mass was performed, and culture yielded Campylobacter fetus subspecies fetus. After intravenous antibiotics, oral doxycycline and erythromycin were given for 5 months. At 9 months after antibiotic treatment was completed, the patient's condition was stable.

CONCLUSIONS

Prolonged oral administration of doxycycline and erythromycin was curative in this patient.

Neurological involvement in a child with the wrinkly skin syndrome

In 1973, a syndrome was reported comprising of wrinkled skin over the dorsum of hands, feet, and abdomen, reduced skin elasticity, skeletal involvement, craniofacial anomalies, mental and developmental delay, and failure to thrive. Only nine cases have been reported. Three additional cases with deletion 2q32 show some manifestations of this syndrome. We present another child with this syndrome with prominent neurological involvement manifested by mental retardation, microcephaly, and an episode of status epilepticus.

Campylobacter upsaliensis-associated diarrhea in human immunodeficiency virus-infected patients

Campylobacter upsaliensis was isolated from the feces of 20 human immunodeficiency virus (HIV)-infected patients with diarrhea over a 67-month period, representing 18.5% of fecal Campylobacter isolates from our HIV-seropositive patients. All isolates were recovered from feces by a 0.45-micron-membrane filtration method. Culture on Skirrow's selective medium incubated at 42 degrees C failed to support any growth. The mean CD4 cell count of the patient group was 185/mm3 (range, 0-840/mm3), and all patients had diarrhea for 1-60 days (mean, 19 days). Thirteen had no other enteric pathogen isolated, and three patients (CD4 counts, < or = 70/mm3) had persistent carriage for between 5 weeks and 3 months. All tested isolates were susceptible to erythromycin and doxycycline, but three isolates from two patients were resistant to ciprofloxacin. C. upsaliensis is associated with prolonged diarrhea of mild to moderate severity in HIV-infected patients.

Campylobacter upsaliensis: waiting in the wings

Despite strong epidemiological evidence supporting an important role for Campylobacter upsaliensis as a human enteropathogen, it remains relatively unknown in the realm of clinical microbiology. Clinical studies indicate that infection with this organism usually is associated with benign self-limiting diarrhea. However, more serious illnesses, including spontaneous abortion and hemolytic-uremic syndrome, recently have been associated with human infections. Understanding of the virulence properties and molecular biology of C. upsaliensis is beginning to evolve. There is now a pressing need for controlled, prospective epidemiologic studies in addition to further in-depth investigation of the pathogenesis of this enteric campylobacter to more precisely define its role in human disease. Furthermore, since C. upsaliensis is sensitive to the antibiotics routinely used in Campylobacter selective media, widespread appreciation of the importance of this organism will rely on the development of widely applicable, effective techniques for its isolation.

Development of quinolone-resistant Campylobacter fetus bacteremia in human immunodeficiency virus-infected patients

Campylobacter fetus subspecies fetus has been recognized as a cause of systemic illness in immunocompromised hosts, including relapsing bacteremia in human immunodeficiency virus (HIV)-infected patients. Acquired resistance to quinolone therapy, while reported for a variety of bacteria, including Campylobacter jejuni, has not been previously documented for C. fetus. Two cases of quinolone-resistant C. fetus bacteremia were detected in HIV-infected patients. Cloning and nucleotide sequencing of the C. fetus gyrA gene in the 2 resistant isolates demonstrated a G-to-T change that led to an Asp-to-Tyr amino acid substitution at a critical residue frequently associated with quinolone resistance. In addition, comparison of the pre- and posttreatment isolates from 1 patient documented outer membrane protein changes temporally linked with the development of resistance. Relapsing C. fetus infections in quinolone-treated HIV-infected patients may be associated with the acquisition of resistance to these agents, and this resistance may be multifactorial.

Assessment of a new triple agent regimen for the eradication of Helicobacter pylori and the nature of H. pylori resistance to this therapy in Japan

BACKGROUND

Multiple regimens for the eradication of Helicobacter pylori have been tested, but the best therapy has not been determined yet. To determine the efficacy of a new triple agent regimen using a combination of lansoprazole, amoxicillin, and clarithromycin against Helicobacter pylori (H. pylori), and to examine H. pylori resistance to this therapy in ineffective cases.

METHODS

We studied a total of 71 patients infected with H. pylori who had gastric ulcer (n = 37) or duodenal ulcer (n = 34) as confirmed by endoscopy. Patients received 1500 mg amoxicillin, 400 mg clarithromycin and 30 mg lansoprazole for 2 weeks followed by 30 mg lansoprazole for 6 weeks in patients with gastric ulcer or for 4 weeks in those with duodenal ulcer. Endoscopic examination was performed before treatment and at 1 month, 2 months, and 5 months after initiating treatment to check the status of ulceration and H. pylori infection.

RESULTS

The eradication rate of H. pylori was 92% (CI, 83-100%) in the gastric ulcer group and 94% (CI, 86-100%) in the duodenal ulcer group at 5 months, as determined by per-protocol analysis. Resistance to clarithromycin was present in 1 of 71 (1%) patients before treatment and in 2 of 5 (40%) patients after treatment. No resistance to amoxicillin and lansoprazole was found in patients before or after treatment. The resistance to clarithromycin changed during the observation period.

CONCLUSIONS

The new triple agent regimen was effective against H. pylori. Resistance to clarithromycin may not be permanent and it might be one of the risk factors which affect the efficacy of a clarithromycin-based therapy.

Purulent pleurisy caused by Campylobacter lari

An 80-year-old debilitated patient developed purulent pleurisy caused by a Campylobacter lari isolate. The patient underwent surgical drainage and received antibiotic therapy with amoxicillin/clavulanic acid and ofloxacin. Antibiotic susceptibility data showed that the isolate was fully sensitive to clarithromycin, tetracycline, aminoglycosides. and ciprofloxacin. Imipenem and amoxicillin plus clavulanic acid were the most active beta-lactam agents.

[Campylobacter fetus endocarditis manifested by a popliteal mycotic aneurysm]

BACKGROUND

Campylobacter fetus endocarditis is uncommon and may be life-threatening.

CASE REPORT

A 91-year-old patient with rectal villous adenocarcinoma was admitted with fever and recent complaints of popliteal pain. The definite diagnosis of endocarditis and mycotic aneurysm related to C. fetus infection were accepted on the basis of clinical, radiological and microbiological data. Cure was achieved with antibiotics and surgery of the aneurysm without valvular replacement.

DISCUSSION

C. fetus endocarditis was probably secondary to the iterative laser treatment of the rectal tumor that had been performed during the past weeks without antibiotic prophylaxis.

Campylobacter jejuni bacteremia in human immunodeficiency virus (HIV)-infected and non-HIV-infected patients: comparison of clinical features and review

Clinical and bacteriologic features and clinical outcomes of culture-confirmed campylobacter bacteremia in 21 patients (including nine human immunodeficiency virus [HIV]-infected subjects and 12 non-HIV-infected subjects) were retrospectively evaluated and compared. This study highlights differences between HIV-infected and non-HIV-infected individuals. Campylobacter jejuni bacteremia in HIV-infected patients was found to often be a severe, debilitating febrile illness requiring multiple and prolonged courses of antibiotic therapy. Extraintestinal features, particularly pulmonary involvement, were often observed. Cellulitis occurred in one patient. By contrast, in non-HIV-infected patients, the illness was generally an acute onset of fever associated with self-limiting enteritis, with fever resolving rapidly with antibiotic treatment. Travel history (42% of cases) appeared to be a common risk factor in the latter group. Two of these patients had cutaneous manifestations, thus suggesting that some strains may be more invasive. This study suggests that campylobacter bacteremia is an important cause of morbidity and mortality in HIV-infected individuals; the overall mortality rate among HIV-infected patients with bacteremia in this study was 33%. This is not the case for immunocompetent patients, in whom death rarely occurs.

Epidemiologic and clinical features of Campylobacter jejuni infections

Gram-negative bacteria of the genus Campylobacter and of related genera frequently colonize the gastrointestinal tracts of humans, other mammals, and birds. One organism, Campylobacter jejuni, has been recognized as an important human pathogen, usually causing a diarrheal illness. Infection is common throughout the world, but clinical and epidemiologic features differ in developed and developing countries. The high incidence of C. jejuni infections and their propensity to invade tissue and to induce inflammation are compatible with a role in the causation of Guillain-Barré syndrome.

Acute hepatitis associated with Campylobacter jejuni bacteraemia

A case of acute hepatitis associated with Campylobacter jejuni bacteraemia is reported. Transaminase levels were increased over 50-fold in a patient with clinical features of enteritis and septicaemia. Campylobacter jejuni was isolated from blood and faecal cultures. Other infective and noninfective causes of acute hepatitis were excluded. The patient's symptoms and liver function values improved after antimicrobial therapy. Hepatitis should be considered as a complication of human Campylobacter jejuni infection.

Norfloxacin resistance in Campylobacter jejuni and Campylobacter coli isolates from Swedish patients

This study focused on the frequency of Campylobacter jejuni and Campylobacter coli strains resistant to norfloxacin. Included were 1659 consecutive stool specimens isolated between 1992 and 1995, from as many Swedish patients with diarrhoea. The patients were divided with regard to place of infection and age. All strains were tested for susceptibility to norfloxacin by means of disc diffusion test on blood-agar plates. Norfloxacin-resistant strains (n = 310) were furthermore tested for resistance to doxycycline and erythromycin. The Etest was used for determination of MIC values of doxycyclin, erythromycin and norfloxacin of 81 of the strains. C. jejuni and C. coli isolations resistant to norfloxacin were significantly more frequent among patients infected abroad, especially in Spain and Thailand, compared with those infected in Sweden, adults more often than children. The number of resistant strains showed a yearly increase, and the difference between children and adults was equalized in 1995. The MIC50 and MIC90 values for doxycycline and erythromycin have increased markedly through the 4 years studied. This study shows that norfloxacin, because of increased resistance, may have limited utility for treatment of gastrointestinal infections caused by C. jejuni and C. coli.

Etiology of bloody diarrhea in Bolivian children: implications for empiric therapy. Bolivian Dysentery Study Group

In Bolivia, few data are available to guide empiric therapy for bloody diarrhea. A study was conducted between December 1994 and April 1995 to identify organisms causing bloody diarrhea in Bolivian children. Rectal swabs from children <5 years old with bloody diarrhea were examined for Salmonella, Shigella, and Campylobacter organisms; fecal specimens were examined for Entamoeba histolytica. A bacterial pathogen was identified in specimens from 55 patients (41%). Shigella organisms were found in 39 specimens (29%); 37 isolates (95%) were resistant to ampicillin, 35 (90%) to trimethoprim-sulfamethoxazole, and 24 (62%) to chloramphenicol, but all were susceptible to nalidixic acid. Only 1 of 133 stool specimens contained E. histolytica trophozoites. Multidrug-resistant Shigella species are a frequent cause of bloody diarrhea in Bolivian children; E. histolytica is uncommon. Clinical predictors described in this study may help identify patients most likely to have Shigella infection. Laboratory surveillance is essential to monitor antimicrobial resistance and guide empiric treatment.

Disc susceptibility testing for thermomphilic campylobacters

The minimum inhibitory concentrations (MICs) and zone diameters around NCCLS strength discs of 100 clinical isolates of thermophilic Campylobacter species, including 79 strains of Campylobacter jejuni subsp. jejuni, 19 of C. coli and two of C. lari, plus three type strains of these species, were determined for erythromycin, clindamycin, nalidixic acid, norfloxacin, ciprofloxacin, ampicillin, piperacillin, cephalothin, ceftriaxone, chloramphenicol, gentamicin and tetracycline. Using error-rate bounded analysis and adjustment of MIC breakpoints to fit natural populations, tentative interpretive zone diameter criteria were set for each of the antimicrobials. Application of these criteria showed that resistance to quinolones was not detected in species other than C. lari. Two strains of C. jejuni subsp. jejuni were susceptible to cephalothin. The type strain of C. lari was susceptible to erythromycin and resistant to clindamycin. Full resistance to erythromycin, chloramphenicol or gentamicin was not found in any strain, while nine strains were resistant to tetracycline. This disc method should provide a simple approach to resistance detection for surveillance or routine testing of invasive isolates.

Prevalence of bacterial enteropathogens in pet dogs in Trinidad

The rectal swabs of diarrhoeic and apparently healthy non-diarrhoeic dogs presented to a Small Animal Clinic were cultured for Escherichia coli, Salmonella and Campylobacter and the enteropathogens were characterized. Overall, of 130 dogs divided equally into two groups consisting of 65 diarrhoeic and 65 non-diarrhoeic dogs, 99 (76.2%), 6 (4.6%) and 18 (13.8%) were positive for E. coli, Salmonella and Campylobacter, respectively. The differences were statistically significant (P < or = 0.05; chi 2). The prevalences of the enteropathogens in diarrhoeic and non-diarrhoeic dogs were not statistically significant (P > or = 0.05; chi 2). Diarrhoea was significantly (P < or = 0.01; chi 2) more prevalent in dogs less than 6 months of age and 7 months to 1 year old than in dogs older than 1 year. The prevalences of Salmonella, E. coli and enteropathogenic E. coli (EPEC) strains were not significantly (P > or = 0.05; chi 2) associated with age but the prevalence of Campylobacter infection was significantly (P < or = 0.01; chi 2) higher in dogs less than 1 year old (25.0%) than in older dogs (5.4%). Of 99 E. coli strains tested, three (3.0%), four (4.0%), five (5.1%) and 20 (20.2%) were haemolytic, non-sorbitol fermenters, verocytotoxigenic (VT) and EPEC strains, respectively. Resistance to tetracycline (59.6%) and ampicillin (50.5%) was most prevalent and significantly (P < or = 0.01; chi 2) higher than to six other antimicrobial agents.

[Pharmacokinetic, bacteriological and clinical studies on azithromycin in children]

Azithromycin (AZM) in fine granules was studied for its pharmacokinetics and clinical efficacies in eight child patients with ages between 1 month and 8 years. Informed consent was received from all of their parents. AZM was administered to the patients once a day at a dose of 10 mg/kg for 3 days. The clinical efficacies of AZM in 8 patients with microbial infections (pneumonia in one, Mycoplasma pneumonia in two, acute tonsillitis in one, pertussis in one, Campylobacter enteritis in one, infectious enteritis in one, Salmonella enteritis in one) were evaluated as "excellent" in five cases, "good" in two and "not evaluable" in one. As for the microbial efficacy, isolated strains were eradicated in 2 out of 3 patients. No adverse reaction was found except for one case with abnormal laboratory change, that is mildly increased GPT value. Plasma samples were collected from 3 cases. The elimination half-life of AZM was 45.8 hours. AUC0-infinity was 12.6 micrograms.hr/ml. Urine sample was collected from one. AZM concentration in urine was 35.0 micrograms/ml during a period between 48 and 72 hours after the start of treatment.

[Campylobacter infections in pregnancy]

In two pregnant women aged 39 and 35, who presented with fever and diarrhoea, Campylobacter was cultured from a blood sample. They were treated with antibiotics. One had a healthy neonate, in the other intrauterine foetal death had occurred. Campylobacter species have increasingly been recognized as possible causes of septic abortion, premature labour and neonatal sepsis. Early recognition and treatment of maternal Campylobacter infection may reduce the risk of serious foetal or neonatal complications.

Campylobacter jejuni peritonitis in a patient with liver cirrhosis

A 56-year-old man with alcoholic liver cirrhosis (Child-Pugh class C), ascites and hepatocellular carcinoma developed acute diarrhoea and fever. Ascites granulocyte count was 5760 per microliters. Campylobacter jejuni grew in cultures from faeces, blood and ascites. The patient was successfully treated with erythromycin. Although the incidence of bacterial infections including peritonitis is high in patients with end-stage liver cirrhosis, this is one of very few cases in which Campylobacter jejuni has been identified as the causative microorganism.

[Campylobacter fetus meningitis in adults]

Campylobacter fetus is an uncommon cause of meningitis in the adult. We report a case observed in an 84-year-old man with alcoholic cirrhosis. The patient presented fever, jaundice and a state of mental confusion. Blood and cerebrospinal fluid cultures identified Campylobacter fetus sensitive to several antibiotics. Ciprofloxacine-ceftriaxone combination replaced the antibiotics prescribed empirically prior to identification and led to regression of the fever and normal mental status within 4 days. Spinal tap on day 7 showed 20 white cells, 85% lymphocytes and normal protein level. Unfortunately, the patient later developed edema and ascitis with major jaundice. Oligo-anuria could not be controlled and the patient died two weeks after admission. Campylobacter fetus meningitis is predominantly seen in men, mean age of onset 50 years. Clinical signs are not specific and diagnosis can only be obtained on the basis of cerebrospinal fluid results. Adapted antibiotics are required.

Infective endocarditis caused by Campylobacter fetus after allogeneic tooth transplantation: a case report

A patient developed infective endocarditis caused by Campylobacter fetus. He gave a history of recent dental extraction and allogeneic tooth transplantation. He was treated with various antibodies to which the organism was said to be sensitive, but it was not until the transplanted tooth was removed that he started to improve. The mode of infection was thought to be blood borne through the open tooth socket from the raw chicken that he ate regularly.

Empirical treatment of severe acute community-acquired gastroenteritis with ciprofloxacin

We conducted a randomized controlled trial to determine whether empirical treatment of severe acute community-acquired gastroenteritis (four fluid stools per day for > 3 days) with ciprofloxacin reduces the duration of diarrhea and other symptoms and to determine what effect ciprofloxacin has on the duration of long-term fecal carriage of gastrointestinal pathogens. A total of 173 patients were recruited for the study and received either ciprofloxacin (500 mg b.i.d.) or placebo for 5 days, during which time they recorded the duration of diarrhea and other symptoms (fever, abdominal pain, vomiting, and myalgia). Fecal samples were collected before treatment and regularly after treatment to determine the duration of carriage of gastrointestinal pathogens. Antibiotic susceptibility tests were performed, and the minimum inhibitory concentrations (MICs) of ciprofloxacin were determined. A significant reduction in the duration of diarrhea and other symptoms was observed after treatment, regardless of whether a pathogen was detected (P = .0001). Treatment failure occurred in 3 of 81 patients in the ciprofloxacin group and 17 of 81 patients in the placebo group. Significant pathogens were detected in 87% of patients, 85.5% of whom had cleared the pathogen at the end of treatment with ciprofloxacin, as compared with 34% who received placebo. Six weeks after treatment, there was no difference between the two groups in terms of the pathogen carriage rate (12%). Treatment with ciprofloxacin did not prolong carriage. High-level resistance to ciprofloxacin (MIC, > 32 mg/L) was detected in three strains (4%) of Campylobacter species.

Campylobacter bacteremia in children

OBJECTIVE

To describe clinical and laboratory data for, and to propose pathogenesis and management of, children from impoverished communities with Campylobacter bacteremia.

METHODS

A retrospective review of patient data generated from laboratory records in an urban tertiary care hospital in Soweto and a rural mission hospital in Eastern Transvaal, South Africa. Participants were 19 children presenting to either hospital with Campylobacter bacteremia. Clinical and laboratory data were collated.

RESULTS

Nineteen children with Campylobacter bacteremia were identified; all isolates were Campylobacter jejuni. Sixteen (84%) had malnutrition; 13 of these were severely malnourished. Thirteen (68%) were febrile at the time of bacteremia. Four children (21%) did not have diarrhea. The case fatality rate was 16% and may not have been influenced by aminoglycoside administration.

CONCLUSION

Malnourished children may be more likely to have gastrointestinal C. jejuni infection. Immunodeficiency and intestinal mucosal compromise secondary to malnutrition may render such children at increased risk of C. jejuni bacteremia and its consequences. C. jejuni bacteremia is potentially life-threatening and should be managed accordingly.

Quinolone resistance and Campylobacter spp

Campylobacter are a frequent cause of diarrhoea in man. The in-vitro susceptibility of all species to the fluoroquinolones and the good response observed in early clinical trials has led to the proposal that these agents may be useful in the treatment of campylobacter enteritis and other more complicated campylobacter infections. However, fluoroquinolone-resistant campylobacters have been reported in up to 50% of isolates from man. The numbers of resistant isolates varies both between and within countries, factors associated with this include foreign travel, local usage of fluoroquinolones, especially in animal husbandry, and whether the microbiology laboratory tests for susceptibility to fluorinated agents, or just nalidixic acid. Fluoroquinolone-resistant campylobacter have emerged during therapy with fluoroquinolones and been responsible for treatment failure. The mechanism of resistance in most isolates is due to mutation in the gyrA (at threonine 86) gene which encodes the A subunit of DNA gyrase. The suggestion of cross resistance to non-quinolone antibiotics, such as tetracycline and/or erythromycin, is probably explained by coincidental occurrence in isolates already resistant to such drugs. The proposal that the veterinary use of fluoroquinolones has led to the selection of fluoroquinolone-resistant campylobacters in poultry which then enter the food-chain to infect man has been viewed as controversial. In the UK fluoroquinolone were only licensed for this use in 1993; it will be interesting to see whether resistant isolates increase the number, thereby lending support for this hypothesis.

Acute cholecystitis caused by Campylobacter jejuni

An 83-year-old man with acute cholecystitis caused by Campylobacter jejuni is described. The patient was cured after undergoing cholecystectomy and intravenous ofloxacin therapy.

Emergence of multidrug resistance in Campylobacter jejuni isolates from three patients infected with human immunodeficiency virus

Single-drug resistance to tetracycline, doxycycline, erythromycin, or fluoroquinolones in Campylobacter isolates recovered from humans has been documented worldwide. Multidrug resistance to these antibiotics is rare in Campylobacter jejuni. We report the sequential development of multidrug resistance in C. jejuni isolates from three patients who were infected with human immunodeficiency virus. Multiple isolates recovered from stool specimens from these patients were ribotyped, and antibiotic susceptibility profiles were determined. The results indicated that each patient was infected with a single strain of C. jejuni that had progressively acquired resistance to the antibiotics used during treatment. The emergence of resistant isolates appeared to correlate with clinical relapse. In these patients, campylobacter enteritis was prolonged, severe, and relapsing, and antimicrobial therapy was required. Once these first-line antibiotics become ineffective, few other antibiotics are available for treating patients with campylobacter enteritis. Acquisition of antibiotic resistance in C. jejuni is therefore of concern in these cases.

Use of azithromycin for the treatment of Campylobacter enteritis in travelers to Thailand, an area where ciprofloxacin resistance is prevalent

We evaluated the use of azithromycin (500 mg) or ciprofloxacin (500 mg) daily for 3 days for the treatment of acute diarrhea among United States military personnel in Thailand. Stool cultures were obtained and symptoms were recorded on study days 0, 1, 2, 3, and 10. Campylobacter species were the most common pathogen isolated (44 isolates from 42 patients). All Campylobacter isolates were susceptible to azithromycin; 22 were resistant to ciprofloxacin. Among the 42 patients with campylobacter infection, there were 2 clinical and 6 bacteriologic treatment failures in the ciprofloxacin group and no treatment failures in the azithromycin group (P = .021 for bacteriologic failures). Overall, azithromycin was as effective as ciprofloxacin in decreasing the duration of illness (36.9 hours vs. 38.2 hours, respectively) and the number of stools (6.4 vs. 7.8, respectively). Among those not infected with Campylobacter species (n = 30), the duration of illness was 32.9 hours vs. 20.7 hours (P = .03) for the azithromycin and ciprofloxacin groups, respectively. Azithromycin is superior to ciprofloxacin in decreasing the excretion of Campylobacter species and as effective as ciprofloxacin in shortening the duration of illness. Azithromycin therapy may be an effective alternative to ciprofloxacin therapy in areas where ciprofloxacin-resistant Campylobacter species are prevalent.

A placebo controlled evaluation of lomefloxacin in the treatment of bacterial diarrhoea in the community

We compared 40 patients taking lomefloxacin 400 mg once daily for 5 days in a double blind trial with 44 placebo takers with proven community acquired bacterial diarrhoea (85% due to Campylobacter spp.). Lomefloxacin eradicated Campylobacter spp. in 75% but did not alter clinical outcome. Twenty-eight per cent of the campylobacter isolates developed resistance. Thirty-three per cent developed side-effects. Lomefloxacin is not recommended for community-acquired bacterial diarrhoea when Campylobacter spp. predominate.