## Chlamydia Treatment in Pregnancy **Key Point:** Tetracyclines are absolutely contraindicated in pregnancy due to teratogenic effects and risk of permanent tooth discoloration in the fetus. Doxycycline and other tetracyclines are **Pregnancy Category D** agents. ### Safe and Unsafe Agents in Pregnancy | Antibiotic Class | Safety in Pregnancy | Notes | |---|---|---| | **Macrolides** (azithromycin) | **SAFE** (Category B) | First-line for pregnant women; effective against *C. trachomatis* | | **Fluoroquinolones** (ofloxacin) | **AVOID** (Category C) | Relative contraindication; safer alternatives available | | **Beta-lactams** (amoxicillin) | **SAFE** (Category B) | Alternative option; less preferred but acceptable | | **Tetracyclines** (doxycycline) | **CONTRAINDICATED** (Category D) | Teratogenic; causes fetal tooth discoloration and bone hypoplasia | **High-Yield:** The **DOC for chlamydial urogenital infection in pregnancy is azithromycin 1 g single dose** (or 500 mg daily × 3 days). Amoxicillin 500 mg TDS × 7 days is an acceptable alternative if macrolide is contraindicated. **Warning:** Doxycycline is the preferred agent in non-pregnant patients (100 mg BD × 7 days), but MUST be avoided in pregnancy and lactation. This is a common exam trap. **Clinical Pearl:** Pregnant women with chlamydial infection require treatment to prevent neonatal conjunctivitis (ophthalmia neonatorum) and pneumonitis. Maternal treatment during pregnancy is more effective than neonatal prophylaxis alone. **Mnemonic:** **TAD** = **T**etracyclines **A**void in pregnancy (teratogenic), **D**oxycycline dangerous. [cite:KD Tripathi 8e Ch 57] 
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