Ciprofloxacin

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 Wattum 2019, van den Oever 1998)}. No problems attributable to ciprofloxacin 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 ^{(Newby 2017, Dutta 2006, Belet 2004, Drossou 2004, Chin 2001, van den Oever 1998, Gürpinar 1997)}. Quinolone-related medication 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, Neuvonen 1991)}

A single case of pseudoembranous colitis has been published in a two-month-old infant whose mother was taking ciprofloxacin ^{(Harmon 1992)}, but both he had suffered a necrotizing enterocolitis with prolonged hospitalization in the neonatal period, and we do not know the dose took the mother, are confounding factors. ^{(Briggs 2017)}

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 possibility of transient gastroenteritis due to alteration of the intestinal flora in infants whose mothers take antibiotics should be taken into account. ^{(Briggs 2017, Ito 1993)}

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, recommending avoiding long-term treatments.^{(Huang 2016, McConnell 2016, Kaplan 2015, Butler 2014, Huang 2014, Schulze 2014, Chen 2010, Spencer 2008, Nahum 2006, Mahadevan 2006, Bar-Oz 2003, Chin 2001)}

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)}

There is no good quality scientific evidence to support the use of ciprofloxacin as the treatment of choice for mastitis. Unreasonably prolonged or repetitive use of antibiotics is harmful to health.

Due to the publication of reports of serious or potentially serious side effects in patients treated with fluoroquinolones, several health authorities propose restricting their indiscriminate outpatient use and reserving them for certain serious diseases. ^{(EMA 2018, FDA 2016)}