Cipro Use During Pregnancy
Our pharmacist answers the latest question regarding Cipro (Ciprofloxacin) use during pregnancy.
Is it okay to use ciprofloxacin drug in one month old pregnancy to treat bacterial infections?
It is not typically recommended to take ciprofloxacin while pregnant although I have seen some doctors prescribe it for them.
It is classified as FDA pregnancy risk category C, meaning that the risks are relatively unknown in pregnant patients as there are no adequate and well-controlled studies in pregnant women. It IS known that cipro crosses the placenta so your unborn baby will be exposed to the drug.
While there has not been well-controlled studies in women, there have been some reviews done. An expert review of published data examined the effect of ciprofloxacin in women exposed to the drug during the first trimester found that ciprofloxacin during pregnancy is not likely to cause teratogenic effects. The data however was deemed insufficient to conclude that there was no risk.
Two other studies followed women exposed to fluoroquinolones (of which cipro is a part of) during pregnancy. The first study followed 200 women exposed to fluoroquinolones. Exposure to fluoroquinolones was not associated with an increased risk of major malformations in this study. Another prospective follow-up study reported on 549 pregnancies with fluoroquinolone exposure (93% first trimester exposures). There were 70 ciprofloxacin exposures, all within the first trimester. No specific patterns of congenital abnormalities were found. The study did not reveal any clear adverse reactions. The manufacturer of ciprofloxacin reports that these data are insufficient to evaluate the risk for less common defects or to permit reliable and definitive conclusions regarding the safety of ciprofloxacin in pregnant women and their developing fetuses.
In addition to the above information, fluoroquinolones (ciprofloxacin, etc) are associated with cartilage damage in animals. Even though this isn't confirmed in humans, it is recommended to try to avoid fluoroquinolones during pregnancy.
So, if ciprofloxacin is not highly recommended, what is?
There isn't a clear cut answer. Penicillins and cephalosporins are usually safe. These drugs include penicillin, amoxicillin, Augmentin, cephalexin and more. Erythromycin, azithromycin, clindamycin, vancomycin and gentamycin are also generally safe in pregnancy.
The following is generally NOT recommended in general:
- Bactrim (TMP/SMX) should in most cases be avoided. Trimethoprim may cause birth defects during the 1st trimester. Sulfamethoxazole may cause high bilirubin and jaundice in the baby if given near term.
- Metronidazole is usually avoided in the 1st trimester due to concerns about possible fetal abnormalities and dysfunction.