Is Cipro (ciprofloxacin) safe for breastfeeding mothers?

Ciprofloxacin Safety During Breastfeeding

Ciprofloxacin is considered possibly safe during breastfeeding as the amount excreted into breast milk is minimal and significantly below therapeutic infant doses. 1

Safety Profile and Milk Transfer

• Ciprofloxacin passes into breast milk but in concentrations two orders of magnitude lower than therapeutic infant doses 1
• Absorption of ciprofloxacin from breast milk is further reduced because the high calcium content in breast milk inhibits drug absorption 1
• The FDA label notes that ciprofloxacin is excreted in human milk, but the amount absorbed by the nursing infant is unknown 2

Risk Assessment

• Despite theoretical concerns about cartilage damage based on animal studies, human data suggest low risk when used during breastfeeding 1, 3
• Studies report no substantial increase in osteoarticular toxicity even with direct systemic use of ciprofloxacin in neonates and children 3
• The FDA label states that "because of the potential for serious adverse reactions in infants nursing from mothers taking ciprofloxacin, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother" 2

Recommendations for Use During Breastfeeding

• To minimize infant exposure, breastfeeding can be timed to correspond with the lowest concentration of ciprofloxacin in breast milk, which occurs 3-4 hours after each maternal dose 1
• Interrupting breastfeeding during ciprofloxacin treatment is generally unnecessary given the low levels in milk and minimal risk 3
• Monitor the breastfed infant for potential side effects such as changes in stool patterns, fussiness, or rash 1

Clinical Context and Alternatives

• If a fluoroquinolone is indicated for a breastfeeding mother, ciprofloxacin should be chosen as the preferred agent in this class 1
• For certain infections like meningococcal disease prophylaxis, ciprofloxacin (500 mg single dose) is recommended for adults, though the FDA label notes caution with breastfeeding 4
• When possible, consider alternative antibiotics with more established safety profiles during breastfeeding, particularly for non-urgent infections 1

Important Considerations

• The benefits of maintaining good maternal health through appropriate antibiotic treatment generally outweigh the theoretical risks of medication exposure through breast milk 3, 5
• Risk assessment should not only consider the drug's potential risk for the breastfed infant but should always account for the benefits of breastfeeding and risks of untreated maternal infection 5
• Most systemic antibiotics will be present in breast milk and could potentially alter intestinal flora in the infant, but this is rarely clinically significant 1