Cipro Rxs

[KUMoose]

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First, I'm a pharmacy student and I'm asking this to get a sense of what physicians do outside my little corner of the world, I've already talked to them.

As one of the assignments (i.e. done and turned in) I had the lovely chance to answer this question:

"A recent mother of a full term baby needs to be put on a single dose of Cipro 500mg. Does she need to discontinue breast-feeding? And if she needs to discontinue breast-feeding for how long?"

After researching all the wealth of studies *cough* and having to blow dust off of a couple of journals I went to cumulative sources and the package insert. Harriet Lane says it's ok (breast feed cat 1), Epocrates only gives probably safe and Lexi-Comp/Package insert says to d/c breast feeding.

Jump foward two weeks and I'm talking with friends (pharm and md students) about the quest and a fierce discussion errupted (woo). For the purpose of the question assume that there's no other reason to stop breast-feeding aside from the Cipro dose and that she's already successfully breast fed for a few days.

If it's an issue, I will post my response, but I'm not looking to turn this into a critique of my answer, just wanted honest opinions from people actually able to prescribe. 😉

 

[fuzzyerin]

What exactly are you treating with one dose of Cipro? Even uncomplicated cystitis I'd treat for 3 days....

 

[Global Disrobal]

I too have to ask about the logic of one dose Cipro regimen, unless it is a hypothetical scenario and you just want to see what the answers will be.

Cipro does cross into the infant via breast milk. As the company recommends, either the mother must stop breast feeding or stop the use of Cipro. Generally, I have not used Cipro in breast feeding mothers because there were other options available, and I did not want to interrupt the breast feeding. Although many sources report that it is safe in the infant, I doubt going against the manufacturers warning is wise.

Finally and interestingly, there is a case report of pseudomembranous colitis in an infant whose mom used Cipro... just a fun fact!

 

[KUMoose]

It's an exercise in information gathering and processing, so it's not suppose to make prescribing sense. 😉 Call this an exercise in where the rubber meets the road.


I did see and read that specific case study, interestingly the case report states that there was no ciprofloxacin in the baby's serum, but that CDiffTox was found in the baby's stool leading to a colostomy... (I forgot specifics, its in my notes somewhere). I read that as "it appears a significant portion of cipro passed through the baby's stomach and into the intestines". I also read or skimmed the previous studies that mentioned cartilage/musculoskeletal problems and a couple of subsequent studies that show the amount the infant receives is less then a standard dose for their surface area. I also skimmed the 4 or 5 abstracts that involved camel's milk. I now know more about camels milk, then I've ever wanted to know in this lifetime.