Ciprofloxacin (Cipro) During Pregnancy: Is It Safe?

What does the evidence say about ciprofloxacin during pregnancy?

1. Most research hasn't found an increased chance of birth defects when ciprofloxacin is taken in the first trimester; among 7 reported cases of longer use lasting 3 weeks to 3 months, no increased chance of birth defects was reported either. 1
2. Studies of more than 2,000 first-trimester ciprofloxacin exposures didn't find a higher miscarriage rate, though the same fact sheet notes other information suggests early-pregnancy use may raise miscarriage risk with the cause unclear, and one study linked third-trimester use to more hyperactivity and attention problems in exposed children. 2
3. Ciprofloxacin carries an FDA boxed warning for tendinitis and tendon rupture, most often affecting the Achilles tendon, and fluoroquinolones are generally reserved in pregnancy for compelling situations, such as inhalational anthrax, rather than routine first-choice use. 3
4. Cipro passes into breast milk in small amounts; across 13 case reports of ciprofloxacin use while breastfeeding, nursing infants received much less than a typical infant dose given directly, and providers suggest watching for diarrhea or a yeast infection like thrush or diaper rash. 1
5. A pharmacovigilance analysis of fluoroquinolone-linked pregnancy adverse-event reports found ciprofloxacin had the strongest statistical signal for spontaneous abortion among the group studied and accounted for about 75 percent of all fluoroquinolone-related reports in the database, though signal-detection studies like this can't prove the drug caused the outcome. 4

Is ciprofloxacin safe in each trimester?

• First trimester. Most research on first-trimester ciprofloxacin exposure, including studies covering more than 2,000 pregnancies, hasn't found a higher chance of birth defects or miscarriage, though some other data has linked early use to a possible miscarriage signal that's hard to separate from the underlying infection itself.
• Second trimester. Fluoroquinolones like ciprofloxacin are generally reserved for infections that don't respond to more established options in pregnancy, given an FDA boxed warning for tendon rupture that applies to everyone who takes the drug, not just pregnant people.
• Third trimester. One study found third-trimester ciprofloxacin exposure was linked to a higher chance of hyperactivity and attention difficulties in exposed children later on. If you're breastfeeding after delivery, a small amount passes into milk, and it's worth watching your baby for diarrhea or signs of a yeast infection.