From the FDA Drug Label
Urogenital Infections During Pregnancy Due to Chlamydia trachomatis Although the optimal dose and duration of therapy have not been established, the suggested treatment is 500 mg of erythromycin by mouth four times a day on an empty stomach for at least 7 days For women who cannot tolerate this regimen, a decreased dose of one erythromycin 500 mg tablet orally every 12 hours or 250 mg by mouth four times a day should be used for at least 14 days. For patients with nongonococcal urethritis caused by Ureaplasma urealyticum when tetracycline is contraindicated or not tolerated 500 mg of erythromycin by mouth four times a day for at least seven days.
The recommended treatment for mycoplasma infections (specifically Ureaplasma urealyticum) during pregnancy is 500 mg of erythromycin by mouth four times a day for at least 7 days. If the patient cannot tolerate this regimen, a decreased dose of one erythromycin 500 mg tablet orally every 12 hours or 250 mg by mouth four times a day should be used for at least 14 days 1.
From the Research
The recommended treatment for mycoplasma infections during pregnancy is azithromycin, which is considered the first-line antibiotic therapy. A typical regimen consists of 500 mg orally on day one, followed by 250 mg daily for four additional days 2. Azithromycin is preferred during pregnancy because it has been extensively studied and demonstrates good safety profiles for both mother and fetus. The dosing schedule of azithromycin may vary between guidelines, but all studies recommend azithromycin as the first-line treatment and advise against moxifloxacin use 2.
Some key points to consider when treating mycoplasma infections during pregnancy include:
- Azithromycin is the first-line treatment for macrolide susceptible or unknown resistance infections 2
- There is a lack of consistency regarding dosing of azithromycin or the utility/safety of pristinamycin for macrolide resistant infections in pregnancy/lactation 2
- Azithromycin-resistant mycoplasma infection requires timely intervention and can increase the risk of adverse pregnancy outcomes 3
- Alternative options include amoxicillin (500 mg three times daily for seven days) if azithromycin cannot be used, but tetracyclines and fluoroquinolones should be avoided during pregnancy due to potential adverse effects on fetal development
It's also important to note that treatment is important because untreated mycoplasma infections may be associated with adverse pregnancy outcomes including preterm birth, low birth weight, and in some cases, respiratory infections in newborns. Sexual partners should also be treated simultaneously to prevent reinfection. Follow-up testing after treatment completion is recommended to ensure the infection has been cleared, particularly in high-risk pregnancies.