Is Ciprofloxacin compatible with breastfeeding? Do we have alternatives for Ciprofloxacin?

Ciprofloxacin

March 21, 2018 (Very Low Risk)

Fluoroquinolone with bactericidal effect by inhibition of bacterial DNA synthesis.
Oral administration twice a daily.

It is excreted in tiny amounts into breast milk. (Gardner 1992, Cover 1990, Giamarellou 1989), much lower than the dose used to treat newborns or infants (van den Oever 1998).
No problems have been observed in infants whose mothers took it (Drobac 2005, Gardner 1992).
The plasma levels of these infants were undetectable or very low (Gardner 1992).

Quinolone-related medication has been used in neonates and infants without known side effects (Dutta 2006, Belet 2004, Drossou 2004, Chin 2001, van den Oever 1998, Gürpinar 1997). It is excreted in tiny amounts into breast milk and absorption through the child’s gut may be interfered by calcium in the milk (Fleiss 1992).

One case of pseudomembranose colitis, possibly related to mother ingestion of Ciporfloxacine, in a premature infant has been described who previously was affected of Necrotizing Enterocolitis (Harmon 1992).
Follow-up for diarrhea in the infant is warranted.

Should it be prescribed to a nursing mother Norfloxacine, Ofloxacine and Ciprofloxacine are to be chosen since they have shown a lowest excretion into the milk (Butler 2014).

The possible negativity of cultures in febrile infants whose mothers take antibiotics should be taken into account,

There are authors and medical associations that discourage their use during breastfeeding (van der Woude 2015, Mottet 2009, WHO 2002) and others that do not (Huang 2016, Butler 2014, Huang 2014, Schulze 2014, Chen 2010, Spencer 2008, Nahum 2006, Mahadevan 2006, Bar-Oz 2003, Chin 2001), recommending avoiding long-term treatments.
In a cross-sectional survey of Canadian physicians, only 50% of physicians stopped treatment with ciprofloxacin during breastfeeding (Huang 2016).

American Academy of Pediatrics: medication usually compatible with breastfeeding (AAP 2001).

Alternatives

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • Σιπροφλοξασίνη (Greek)
  • سيبروفلوكساسين (Arabic)
  • Ципрофлоксацин (Cyrillic)
  • 环丙沙星 (Chinese)
  • シプロフロキサシン (Japanese)
  • C17 H18 FN3 O3 (Molecular formula)
  • 1-Cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-piperazin-1-ylquinoline-3-carboxylic acid (Chemical name)
  • J01MA02 (ATC Code/s)

References

  1. McConnell RA, Mahadevan U. Pregnancy and the Patient with Inflammatory Bowel Disease: Fertility, Treatment, Delivery, and Complications. Gastroenterol Clin North Am. 2016Abstract
  2. Huang VW, Chang HJ, Kroeker KI, Goodman KJ, Hegadoren KM, Dieleman LA, Fedorak RN. Management of Inflammatory Bowel Disease during Pregnancy and Breastfeeding Varies Widely: A Need for Further Education. Can J Gastroenterol Hepatol. 2016Abstract Full text (link to original source) Full text (in our servers)
  3. van der Woude CJ, Ardizzone S, Bengtson MB, Fiorino G, Fraser G, Katsanos K, Kolacek S, Juillerat P, Mulders AG, Pedersen N, Selinger C, Sebastian S, Sturm A, Zelinkova Z, Magro F; European Crohn’s and Colitis Organization. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis. 2015Abstract Full text (link to original source) Full text (in our servers)
  4. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014Abstract
  5. Huang VW, Habal FM. From conception to delivery: managing the pregnant inflammatory bowel disease patient. World J Gastroenterol. 2014Abstract Full text (link to original source) Full text (in our servers)
  6. Schulze H, Esters P, Dignass A. Review article: the management of Crohn's disease and ulcerative colitis during pregnancy and lactation. Aliment Pharmacol Ther. 2014Abstract Full text (link to original source) Full text (in our servers)
  7. Chen LH, Zeind C, Mackell S, LaPointe T, Mutsch M, Wilson ME. Breastfeeding travelers: precautions and recommendations. J Travel Med. 2010Abstract Full text (link to original source) Full text (in our servers)
  8. Mottet C, Vader JP, Felley C, Froehlich F, Gonvers JJ, Juillerat P, Stockbrügger R, Angelucci E, Seibold F, Michetti P, Pittet V; EPACT II Study Group. Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): Results of a multidisciplinary international expert panel-EPACT II. J Crohns Colitis. 2009Abstract Full text (in our servers)
  9. Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician. 2008Abstract Full text (link to original source) Full text (in our servers)
  10. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006Abstract Full text (link to original source) Full text (in our servers)
  11. Dutta S, Chowdhary G, Kumar P, Mukhopadhay K, Narang A. Ciprofloxacin administration to very low birth weight babies has no effect on linear growth in infancy. J Trop Pediatr. 2006Abstract
  12. Nahum GG, Uhl K, Kennedy DL. Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks. Obstet Gynecol. 2006Abstract
  13. Drobac PC, del Castillo H, Sweetland A, Anca G, Joseph JK, Furin J, Shin S. Treatment of multidrug-resistant tuberculosis during pregnancy: long-term follow-up of 6 children with intrauterine exposure to second-line agents. Clin Infect Dis. 2005Abstract Full text (link to original source) Full text (in our servers)
  14. Drossou-Agakidou V, Roilides E, Papakyriakidou-Koliouska P, Agakidis C, Nikolaides N, Sarafidis K, Kremenopoulos G. Use of ciprofloxacin in neonatal sepsis: lack of adverse effects up to one year. Pediatr Infect Dis J. 2004Abstract
  15. Belet N, Haciömeroğlu P, Küçüködük S. Ciprofloxacin treatment in newborns with multi-drug-resistant nosocomial Pseudomonas infections. Biol Neonate. 2004Abstract
  16. Bar-Oz B, Bulkowstein M, Benyamini L, Greenberg R, Soriano I, Zimmerman D, Bortnik O, Berkovitch M. Use of antibiotic and analgesic drugs during lactation. Drug Saf. 2003Abstract
  17. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  18. Chin KG, McPherson CE 3rd, Hoffman M, Kuchta A, Mactal-Haaf C. Use of anti-infective agents during lactation: Part 2--Aminoglycosides, macrolides, quinolones, sulfonamides, trimethoprim, tetracyclines, chloramphenicol, clindamycin, and metronidazole. J Hum Lact. 2001Abstract
  19. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001Abstract Full text (link to original source) Full text (in our servers)
  20. van den Oever HL, Versteegh FG, Thewessen EA, van den Anker JN, Mouton JW, Neijens HJ. Ciprofloxacin in preterm neonates: case report and review of the literature. Eur J Pediatr. 1998Abstract
  21. Gürpinar AN, Balkan E, Kiliç N, Kiriştioğlu I, Doğruyol H. The effects of a fluoroquinolone on the growth and development of infants. J Int Med Res. 1997Abstract
  22. Fleiss PM. The effect of maternal medications on breastfeeding infants. J Hum Lact. 1992Abstract
  23. Harmon T, Burkhart G, Applebaum H. Perforated pseudomembranous colitis in the breast-fed infant. J Pediatr Surg. 1992Abstract
  24. Gardner DK, Gabbe SG, Harter C. Simultaneous concentrations of ciprofloxacin in breast milk and in serum in mother and breast-fed infant. Clin Pharm. 1992Abstract
  25. Fulton B, Moore LL. Comment: Ciprofloxacin excretion into breast milk. DICP. 1990Abstract
  26. Cover DL, Mueller BA. Ciprofloxacin penetration into human breast milk: a case report. DICP. 1990Abstract
  27. Giamarellou H, Kolokythas E, Petrikkos G, Gazis J, Aravantinos D, Sfikakis P. Pharmacokinetics of three newer quinolones in pregnant and lactating women. Am J Med. 1989Abstract