Pregnancy tetracyclines

Spectinomycin (2 g intramuscularly) is the appropriate choice in this case. Avoid cephalosporins in patients with a history of severe hypersensitivity to penicillins, and avoid fluoroquinolones (see Chapter 46) in pregnancy. Tetracyclines have been used in the past for gonorrhea but not as single doses, and they too should be avoided in pregnancy. The answer is (D). 

The tetracyclines are contraindicated if the patient is known to be hypersensitive to any of the tetracyclines. Tetracyclines also are contraindicated during pregnancy because of die possibility of toxic effects to the developing fetus. The tetracyclines are classified Pregnancy Category D drag. These drug also are contraindicated... 

Tetracycline (Sumycin) Trichomoniasis 500 mg four times daily for 14 days Alternative during lactation (but not pregnancy) for penicillin-allergic patients... 

Treatment of gonorrhea during pregnancy is essential to prevent ophthalmia neonatorum. The CDC recommends that either tetracycline (1%) ophthalmic ointment or erythromycin (0.5%) ophthalmic ointment be instilled in each conjunctival sac immediately postpartum to prevent ophthalmia neonatorum. 

Hepatic function impairment Doses more than 2 g/day IV can be extremely dangerous. In the presence of renal dysfunction, and particularly in pregnancy, IV tetracycline more than 2 g/day has been associated with death secondary to liver failure. Hepatotoxicity has been reported with minocycline. Administer with caution reduce the recommended dosage and/or extend the dosing interval. 

There is little difference in clinical response among the various tetracyclines The selection of an agent, therefore, is based on tolerance, ease of administration, and cost. The restriction of their use in pregnancy and in patients under the age of 8 years apphes to all preparations. 

Orodental infection caused by mixed aerobic, anaerobic bacteria including Vincent s infection caused by Fusobac-terium. Tetracycline also prove to be beneficial in peridontal inflammation by scavenging free radicals. Its use in pregnancy, lactation and in children is contraindicated. Its use in dentistry is very much restricted due to its chelating effect on teeth and bones. 

Tetracyclines can probably impair hepatic function, especially during pregnancy, in patients with preexisting hepatic insufficiency and when high doses are given intravenously. Hepatic necrosis has been reported with daily doses of 4 g or more intravenously. 

Malarone is generally well tolerated. Adverse effects include abdominal pain, nausea, vomiting, diarrhea, headache, and rash, and these are more common with the higher dosage required for treatment. Reversible elevations in liver enzymes have been reported. The safety of atovaquone in pregnancy is unknown. Plasma concentrations of atovaquone are decreased about 50% by co-administration of tetracycline or rifampin. 

Antibiotics also are active against other protozoans. Tetracycline and erythromycin are alternative therapies for the treatment of intestinal amebiasis. Clindamycin, in combination with other agents, is effective therapy for toxoplasmosis, pneumocystosis, and babesiosis. Spiramycin is a macrolide antibiotic that is used to treat primary toxoplasmosis acquired during pregnancy. Treatment lowers the risk of the development of congenital toxoplasmosis. 

Tetracyclines should not be used during pregnancy, lactation, or in children. They should be used cautiously in patients with renal and hepatic insufficiency. The drug should never be used after the expiration date, as it becomes toxic. Tetracyclines should not be administered along with milk, as it chelates calcium. 

Pregnancy All antibiotics cross the placenta. Adverse effects to the fetus are rare, except for tooth dysplasia and inhibition of bone growth encountered with the tetracyclines. However, some anthelmintics are embryotoxic and teratogenic (p. 359). Aminoglycosides should be avoided in pregnancy because of their ototoxic effect in the fetus. 

Tetracyclines induce photosensitisation and other rashes. Liver and pancreatic damage can occur, especially in pregnancy and with renal disease, when the drugs have been given i.v. Rarely tetracyclines cause benign intracranial hypertension, dizziness and other neurological reactions. 

Deposition of tetracyclines in bone tissue has been demonstrated in animals (147) and man (148). However, whereas osseous tissue in adult patients treated with tetracycline has shown deposits only in areas of repair or remodeUing, children s bones contain extensive areas of deposition. Tetracycline deposition in bone has been reported to have an effect on longitudinal bone growth (149). In experimental tissue cultures, osteogenesis was impaired by tetracyclines in concentrations similar to serum concentrations that are associated with a therapeutic effect (that is 1 pg/ml) (150). The deposition of tetracyclines in human bone begins in utero as early as in the first trimester of pregnancy (148). With regular tissue turnover, the deposits disappear. 

The authors mentioned that their previous study had not shown a teratogenic potential of doxycycline (164), but concluded, far more prudently, that all tetracyclines are contraindicated during pregnancy. 

Discoloration of the first teeth is particularly likely if a tetracycline is given to the mother after the third month of pregnancy (165). Tetracyclines pass across the placenta and reach therapeutic concentrations in the fetal circulation (166,167). 

Pregnant women after the third month of pregnancy, nursing women, and children under the age of 8 years should not be treated with tetracyclines, because of the risk of discoloration of the teeth. Besides its merely cosmetic aspect, tooth discoloration in children is associated with enamel defects and hypoplasia in severe cases (169). 

---