Antibiotics generally avoided in the treatment of pregnant patients

* Tetracyclines and tetracycline derivates (including omadacycline and the glycylcycline tigecycline) are generally contraindicated in pregnancy because of the risk of hepatotoxicity in the mother and adverse effects on fetal bone and teeth (eg, permanent discoloration of deciduous teeth from in utero exposure in the second and third trimesters, incorporation into fetal long tubular bones with transient inhibition of growth). These events are rare with doxycycline, in part because it binds less readily to calcium than other tetracycline antibiotics. However, data are low quality and insufficient to say that there is no risk. If there is a safer, effective drug that can be used as an alternative, it should be used. But if there is no good alternative (eg, Rocky Mountain spotted fever), doxycycline should be used rather than tetracycline.

¶ Though there is no human data proving adverse outcome in pregnancy, animal studies clearly show adverse outcomes. Therefore, clarithromycin cannot be recommended for use in pregnancy.

Δ Despite very concerning animal data, increasing human data suggests fluoroquinolones might warrant a role in specific pregnant patients in the future.

◊ Only the erythromycin estolate should be avoided in pregnancy. Other forms of erythromycin, such as erythromycin base, ethyl succinate, or stearate are acceptable.

§ Kanamycin and streptomycin have been associated with fetal ototoxicity. There are theoretical concerns of ototoxicity and nephrotoxicity with all aminoglycosides. However, experience with other aminoglycosides, particularly gentamicin, in treatment of serious infections in pregnancy is reassuring.