From the Guidelines
Ciprofloxacin (Cipro) should be avoided during pregnancy unless absolutely necessary, and only used when the potential benefit justifies the possible risk to the fetus, and when safer alternatives are not available or effective. This recommendation is based on the most recent and highest quality study available, which suggests that while human data indicate a low risk, animal studies have shown adverse effects on developing cartilage associated with fluoroquinolones, the class of antibiotics to which ciprofloxacin belongs 1.
Key Considerations
- Ciprofloxacin belongs to the fluoroquinolone class of antibiotics, which has raised concerns due to its effects on developing cartilage in animal studies.
- Human studies have not conclusively demonstrated harm, but the concern is significant enough that healthcare providers typically avoid prescribing ciprofloxacin during pregnancy, especially during the first trimester.
- If an infection requires treatment during pregnancy, alternative antibiotics with better-established safety profiles, such as certain penicillins, cephalosporins, or macrolides, are usually preferred.
- The decision to use ciprofloxacin during pregnancy should be made by a healthcare provider after carefully weighing the risks and benefits in the specific situation.
Alternatives and Precautions
- Safer alternatives like penicillins and cephalosporins can be given when there is endoscopic evidence of purulence.
- Long-term use of macrolides or doxycycline for chronic rhinosinusitis is not recommended during pregnancy due to potential risks to the fetus.
- Antibiotics that are known to put the fetus at risk, such as tetracyclines, aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones, should be avoided during pregnancy unless no alternative is available and the benefit outweighs the risk 1.
Conclusion Not Applicable - Direct Answer Only
Given the potential risks, ciprofloxacin should only be considered during pregnancy when there are no suitable alternative treatments available, emphasizing the importance of careful risk-benefit assessment by healthcare providers 1.
From the FDA Drug Label
Pregnancy Category C: There are no adequate and well-controlled studies in pregnant women An expert review of published data on experiences with ciprofloxacin use during pregnancy by TERIS - the Teratogen Information System - concluded that therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk (quantity and quality of data=fair), but the data are insufficient to state that there is no risk. Ciprofloxacin should not be used during pregnancy unless the potential benefit justifies the potential risk to both fetus and mother (see WARNINGS).
Ciprofloxacin use in pregnancy is not recommended unless the potential benefit outweighs the potential risk. The available data suggest that therapeutic doses of ciprofloxacin during pregnancy are unlikely to pose a substantial teratogenic risk, but the data are insufficient to confirm complete safety.
- Key points:
- No adequate and well-controlled studies in pregnant women
- Therapeutic doses unlikely to pose substantial teratogenic risk, but data are insufficient to confirm complete safety
- Ciprofloxacin should not be used during pregnancy unless the potential benefit justifies the potential risk to both fetus and mother 2
From the Research
Ciprofloxacin Use in Pregnancy
- Ciprofloxacin, a fluoroquinolone antibiotic, has been a subject of concern for use during pregnancy due to potential risks of teratogenicity and toxicity to the fetus 3, 4, 5, 6.
- Studies have shown that the use of ciprofloxacin during pregnancy may not be associated with an increased risk of malformations or musculoskeletal problems, but longer follow-up and further research are needed to confirm these findings 4, 6.
- A study published in 2019 found that ciprofloxacin affected fetal development, causing damage to neurons in brain tissue and hemorrhagic defects in rats 5.
- However, another study found that quercetin, a flavonoid with strong antioxidant properties, may suppress the harmful effects of ciprofloxacin on fetal brain tissue 5.
- The diffusion of enrofloxacin, a related antibiotic, to pregnancy fluids and its effects on fetal cartilage have also been studied, with results suggesting that short-term administration of enrofloxacin to late gestation mares did not result in macroscopic or microscopic lesions in the fetus 7.
Teratogenic Potential
- The teratogenic potential of ciprofloxacin in humans is considered "unlikely" based on available data 4.
- Assessments of teratogenic potential are based on "fair data" for ciprofloxacin, indicating that while there is some evidence, more research is needed to fully understand the risks 4.