BACKGROUND AND PURPOSE: 

• Quinolones and fluoroquinolones are effective antibiotics but have been restricted in pregnancy due to findings of birth defects and potential for carcinogenesis in animals 
• Biologic plausibility due to mechanism of action 
  • Inhibition of bacterial DNA synthesis  
• Human data is limited  
• Yefet et al. (BJOG, 2018) assessed whether exposure to quinolones during pregnancy increased risk for fetal malformations and pregnancy complications

METHODS: 

• Systematic review and meta-analysis  
  • Included studies that evaluated the association between a quinolone antibiotic and fetal malformations, miscarriages, stillbirth (fetal death >23 weeks), or preterm birth (<37 weeks) 
• Two authors independently selected and assessed trials to avoid bias 
• Subgroup analysis performed for first trimester exposure

RESULTS: 

• 13 studies were included 
  • 9 cohort studies | 4 case-control studies 
  • Controls: Either pregnant and no current antibiotic use, or pregnant and prescribed non-teratogenic antibiotics  
• There was no association found between quinolones and 
  • Fetal malformations: Pooled odds ratio (OR) 1.08; 95% CI, 0.96–1.21 
  • Preterm delivery: Pooled OR 0.97; 95% CI, 0.75–1.24 
  • Stillbirth: Pooled OR 1.11; 95% CI, 0.34–3.6 
  • Miscarriage: Pooled OR 1.78; 95% CI. 0.93–3.38

CONCLUSION: 

• Exposure to quinolones during pregnancy was not associated with an increased risk for malformation, preterm birth, stillbirth, or miscarriage  
• While overall no increased risk of miscarriage, the study did find and increased risk in sub-analysis of a single international study (as opposed to single-country studies)  
  • Occurred at high doses but cannot rule out possible association  
• Authors state that further information from larger studies is still required before quinolone antibiotics can be used as a first line treatment for infections 
• Another recent meta-analysis including 11 studies recently published in Pharmaceutical research (2018) also demonstrated that the use of quinolones during the first-trimester of pregnancy was not associated with an increased risk of birth defects, stillbirths, preterm births or low birth weight

Learn More – Primary Sources: 

(BJOG 2018) The safety of quinolones and fluoroquinolones in pregnancy: a meta‐analysis

(Pharm Res 2018) Pregnancy Outcomes Following Exposure to Quinolone Antibiotics – a Systematic-Review and Meta-Analysis 

Related ObG Topics:

ACOG Guidance on Use of Sulfonamides and Nitrofurantoin for UTIs in the First Trimester

Does Antibiotic Use Increase Risk of Spontaneous Abortion?

Gonorrhea Treatment Pearls