Based on CDC | Is it true that ciprofloxacin is no longer recommended for treating Campylobacter food poisoning acquired from undercooked chicken due to widespread resistance?

Short answer

Ciprofloxacin can still be used for Campylobacter in some situations, but it is generally not preferred first‑line in many places because fluoroquinolone resistance is common. ^[1] In practice, azithromycin is often favored, and antibiotic susceptibility testing is recommended to guide therapy when treatment is needed. ^{[1] [2]}

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Why recommendations shifted

• High resistance rates to ciprofloxacin: Surveillance data have shown substantial ciprofloxacin resistance in Campylobacter isolates, which reduces the likelihood that ciprofloxacin will work. ^[2] Resistance has risen over time and is frequently reported worldwide. ^{[3] [4]}
• Macrolides remain more reliable: Resistance to macrolides such as azithromycin has stayed relatively low compared with fluoroquinolones in many regions, making azithromycin a more dependable option. ^[4]

Put simply, because many Campylobacter strains won’t be killed by ciprofloxacin anymore, clinicians often choose azithromycin unless a lab confirms susceptibility to fluoroquinolones. ^{[1] [2]}

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Current clinical approach

• Most cases are self‑limited: Many people improve without antibiotics; treatment is reserved for severe illness, prolonged symptoms, or high‑risk individuals. ^[1]
• First‑line choice often azithromycin: When antibiotics are indicated, azithromycin is commonly used because resistance to fluoroquinolones is widespread. ^[1]
• Use susceptibility testing: If a culture is obtained, testing the isolate’s sensitivity helps pick an effective drug; this is especially useful in areas with known resistance. ^{[1] [2]}
• Fluoroquinolones may be used if susceptible: If testing shows the organism is sensitive, a fluoroquinolone such as ciprofloxacin can still be considered. ^{[5] [6]}

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What official guidance and data say

• Clinical guidance notes common fluoroquinolone resistance in the U.S., with azithromycin and fluoroquinolones listed as treatment options but advising susceptibility testing. ^[1]
• Recent U.S. surveillance has found roughly a third of C. jejuni and even more C. coli resistant to ciprofloxacin, while azithromycin resistance remains lower. ^[2]
• Guidelines acknowledge increasing fluoroquinolone resistance and present azithromycin or ciprofloxacin as options, ideally guided by susceptibility, with typical courses of about 5–10 days depending on the antibiotic and clinical severity. ^{[7] [5] [6]}

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Practical summary for undercooked chicken exposures

• Campylobacter from poultry is common, and fluoroquinolone resistance in Campylobacter has spread widely through the food chain. ^[3]
• Because resistance to ciprofloxacin is common, azithromycin is generally preferred when antibiotics are needed. ^[1]
• Ciprofloxacin isn’t “banned,” but it’s best reserved for cases where the organism is shown to be susceptible or where local resistance is known to be low. ^{[5] [6] [2]}

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Key takeaways

• Not strictly “no longer recommended,” but often not first‑line due to resistance. ^[1]
• Azithromycin is usually favored for empiric treatment when antibiotics are warranted. ^[1]
• Culture and susceptibility testing help choose the right drug. ^{[1] [2]}

Would you like help deciding whether antibiotics are appropriate for your symptoms and risk factors?