Which antibiotic option is appropriate for Campylobacter or Shigella diarrhea with systemic symptoms?

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The key idea is recognizing when diarrhea caused by invasive pathogens like Campylobacter or Shigella warrants antibiotic therapy due to systemic symptoms such as fever or malaise. Azithromycin, a macrolide, is effective against both Campylobacter jejuni and Shigella species and maintains activity in settings where fluoroquinolone resistance is common. It also tends to be well tolerated and is suitable for populations where fluoroquinolones are less preferred, such as children and pregnant patients. Metronidazole targets anaerobes and certain protozoa, not these enteric pathogens. Doxycycline and amoxicillin have limited reliability against Campylobacter and Shigella due to resistance patterns. Therefore, azithromycin is the most appropriate choice for treating Campylobacter or Shigella diarrhea when systemic symptoms are present.