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Grand Rounds

Could Quinolone Exposure Increase Risk to Fetus?

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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 

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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

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