Cipro v. Levaquin

[cathysamsjones]

I have a mom who 16 days s/p c/s readmitted with wound infection. She was treated inpatient with IV vancomycin (told by surgeon to pump and dump---this was corrected) and then sent home on Cipro. It was a toss between Levaquin and Cipro. Mother has declined to take the Cipro until she gets the breastfeeding OK from me. There are no GI symptoms in the baby at present. Organisms found in culture are K. Pneumoniae, Enterococcus, and E. coli. I would greatly appreciate any recommendations. Thank you.

[cpride]

Dear cathysamsjones,

Cipro is categorized as a L3. The RID is 2.1 to 6.3 percent of mother's dose (typical adult dose 500 mg po bid). The time the drug is most concentrated in mother's milk (T max) is 30 minutes to 2 hours after her dose. The half-life is 4 hours. The mother should be instructed to breastfeed first then take her dose and wait past the T max time, if possible, to further decrease infant exposure. The initial concern about the fluoroquinolone class of antibiotics was the arthropathy noted in newborn animal studies. These medications initially were not used in the pediatric population due to data from these animal studies. Currently, Cipro is being used for serious infections in the pediatric population and generally well tolerated. The mother should observe her infant for gastrointestinal symptoms such as diarrhea. Levaquin's RID is higher at 10.5 to 17.2 percent of the mother's dose so the infant would be exposed to a higher dose. If the bacteria are sensitive to Cipro, that would be a good choice. It has been reported that many strains of Enterococcus are only moderately susceptible to Cipro compared to Levaquin. If the mother's infection does not respond to Cipro, then Levaquin is still compatible with breastfeeding but may cause more gastroinestinal symptoms in the infant. Let me know if you have further questions.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center