Is Cipro (ciprofloxacin) contraindicated in pregnancy?

From the Guidelines

Ciprofloxacin is possibly safe during pregnancy, but it should be avoided if possible due to potential risks to the fetus, particularly fetal cartilage damage, as suggested by animal studies, although human data indicate a low risk 1. When considering the use of ciprofloxacin in pregnant women, it is essential to weigh the potential benefits against the potential risks.

• The medication is classified as category C, indicating that while animal studies have shown adverse effects, there are no adequate well-controlled studies in humans to fully assess the risks.
• Some studies suggest that fluoroquinolones, including ciprofloxacin, may be associated with fetal cartilage damage in animal models, but human data suggest a low risk 1.
• If a fluoroquinolone is indicated, ciprofloxacin should be chosen, as it is considered the safest option among this class of antibiotics during pregnancy 1.
• However, most clinicians try to avoid using ciprofloxacin during pregnancy and lactation due to these potential risks.
• Alternative treatments should be considered first, and if ciprofloxacin is necessary, the lowest effective dose should be used.
• Pregnant women should be closely monitored, and any decision to use ciprofloxacin during pregnancy should be made in consultation with healthcare providers who can weigh individual circumstances.

From the FDA Drug Label

Pregnancy Teratogenic Effects 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 is not absolutely contraindicated in pregnancy, but its use is cautioned against unless the potential benefit justifies the potential risk to both fetus and mother 2.

• The drug label advises against using ciprofloxacin during pregnancy unless necessary.
• There are no adequate and well-controlled studies in pregnant women to fully assess the risk.
• Some studies suggest that therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk, but the data are insufficient to state that there is no risk.

From the Research

Ciprofloxacin Use in Pregnancy

• There is no direct information in the provided studies regarding the use of ciprofloxacin in pregnancy.
• However, the studies discuss the general safety and efficacy of ciprofloxacin and other fluoroquinolones in various populations, including the elderly and patients with certain comorbidities 3, 4, 5, 6.
• One study mentions that ciprofloxacin is one of the few broad-spectrum antibacterials available in both intravenous and oral formulations, which could be relevant in certain clinical situations, but does not specifically address pregnancy 3.
• Another study notes that chondrotoxicity of fluoroquinolones has led to restricted use in pediatric patients, but there is no indication that similar effects could occur in joint cartilage of adults, which may imply a potential concern for fetal development, although this is not explicitly stated 4.
• A review of fluoroquinolones in the elderly population discusses the importance of considering specific adverse effects and comorbidities when using these drugs, but does not address pregnancy directly 6.
• A systematic review of seizures as adverse events of antibiotic drugs, including fluoroquinolones like ciprofloxacin, notes that evidence for antibiotic-related seizures is low to very low, but highlights the importance of monitoring patients with certain predispositions 7.

Summary of Findings

• The provided studies do not directly address the use of ciprofloxacin in pregnancy.
• While the studies discuss the safety and efficacy of ciprofloxacin and other fluoroquinolones in various populations, they do not provide information on the potential risks or benefits of using these drugs during pregnancy 3, 4, 5, 6, 7.