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Campylobacter species are primarily zoonotic pathogens and recognized as a major cause of human illnesses. Poultry, especially, chicken is the main reservoir of Campylobacter species. The uncontrolled use of antibiotics in prophylaxis and treatment of animals caused an increase in antibiotic resistance to macrolides and fluoroquinolones (FQ) which are considered the drugs of choice for treatment of Campylobacter infection. Recently, studies suggested that multidrug efflux systems have the main role in lowering the efficacy of new and old antibiotics. Consequently, efforts are made to find suitable substances to reverse the action of the efflux pumps and prevent antimicrobial resistance. The substances used for evaluation of efflux pumps modulation are either efflux pump inhibitors (EPIs) or efflux pump inducers. The different types of EPIs; phenylalanine arginyl β-naphthylamide, verapamil and phenothiazines, of different mode of actions were used to suppress the activity of different types of efflux pumps. Aspirin, a drug in livestock and poultry, is a nonsteroidal anti-inflammatory, which  induces non-heritable resistance of different bacteria to multiple antibiotics. Moreover, it also increases campylobacter resistance to antimicrobials. Alpha-tocopherol represents a new alternative approach against bacterial resistance. It shows modulatory activity on efflux system, showing clinically relevant results. Therefore, it is important to study different resistance mechanisms of campylobacters.

Macrolides and Fluoroquinolones Resistance Mechanisms in Campylobacters and their Incidence in Egypt; a Review Article