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
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
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
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
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