USE OF QUINOLONES IN PREGNANCY

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(Date of issue: June 2017, Version: 3.1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

The quinolones (including ciprofloxacin, levofloxacin, moxifloxacin, nalidixic acid, norfloxacin and ofloxacin) are broad-spectrum synthetic antibiotics used in the treatment of a wide variety of infections including those of the urinary tract, respiratory-tract, gastro-intestinal system, bones and joints, as well as gonorrhoea, chlamydia and septicaemia. Ciprofloxacin is also used in the treatment or post-exposure prophylaxis of anthrax.

No increased risk of congenital malformations overall, low birth weight, preterm delivery, intrauterine death or neonatal complications have been found for in utero exposure to quinolone antibiotics when studied as a class. Data on offspring malformation risk for individual quinolones are generally limited. Single studies have suggested an association between in utero quinolone exposure and conotruncal defects and Tetralogy of Fallot, and in utero nalidixic acid exposure and infantile pyloric stenosis, however these findings were based on a small number of exposed infants with these anomalies. One study found an increased risk of spontaneous abortion for quinolones as a class and for ciprofloxacin, levofloxacin, norfloxacin, moxifloxacin and oflxacin specifically. Further studies are needed before these associations can be confirmed or refuted.

Neonatal exposure to quinolones have been shown to cause arthropathy in animal studies. Due to the theoretical risk of similar effects on the developing human fetus, the use of quinolones in pregnancy is not generally recommended, except for the treatment of serious or life-threatening conditions unresponsive to other antibiotic therapies considered suitable for use in pregnancy. Where possible, the results of culture and sensitivity tests should be available before making an antibiotic treatment choice in accordance with local prescribing guidelines.

Exposure to quinolones at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.