Can pregnancy be treated with doxycycline (Doxycycline) for Chlamydia (Chlamydia trachomatis) infection?

From the Guidelines

Doxycycline is not recommended during pregnancy for treating chlamydia, and instead, azithromycin or alternative antibiotics such as erythromycin or amoxicillin should be used. The primary concern with doxycycline in pregnancy is its potential to affect fetal bone and tooth development, leading to permanent tooth discoloration and enamel hypoplasia in the developing fetus, as it belongs to the tetracycline class of antibiotics that can cross the placenta and accumulate in fetal bones and teeth 1.

Key Considerations

• Azithromycin is considered safe during all trimesters of pregnancy and is equally effective at treating chlamydial infections, with a recommended regimen of azithromycin 1 gram taken as a single oral dose or alternative regimens as outlined in recent guidelines 1.
• Erythromycin or amoxicillin can also be used as alternative treatments for chlamydia during pregnancy, especially when azithromycin is not suitable, with specific dosages and considerations for potential side effects such as infantile hypertrophic pyloric stenosis with erythromycin 1.
• Prompt treatment of chlamydia in pregnant women is crucial to prevent complications like preterm birth, premature rupture of membranes, and transmission to the newborn, which can cause eye infections or pneumonia in the baby, emphasizing the importance of choosing an appropriate antibiotic regimen based on the most current evidence and guidelines 1.

Treatment Options

• Azithromycin: 1 gram taken as a single oral dose, or alternative regimens as specified in the guidelines.
• Erythromycin: with considerations for potential side effects and the need for careful monitoring.
• Amoxicillin: as an alternative when other options are not suitable, with specific dosing recommendations based on the latest guidelines.

From the FDA Drug Label

Pregnancy: Teratogenic effects. Pregnancy Category D: There are no adequate and well-controlled studies on the use of doxycycline in pregnant women The vast majority of reported experience with doxycycline during human pregnancy is short-term, first trimester exposure. An expert review of published data on experiences with doxycycline use during pregnancy by TERIS – the Teratogen Information System – concluded that therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk (the quantity and quality of data were assessed as limited to fair), but the data are insufficient to state that there is no risk

Pregnancy and Doxycycline Use:

• The FDA drug label indicates that doxycycline is a Pregnancy Category D drug, meaning there is evidence of risk to the human fetus.
• There are no adequate and well-controlled studies on the use of doxycycline in pregnant women.
• The data available are insufficient to state that there is no risk of teratogenic effects.
• Therefore, doxycycline should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus.
• In the case of chlamydia, alternative treatments should be considered for pregnant women, as the risk of doxycycline to the fetus cannot be ruled out 2.

From the Research

Treatment Options for Chlamydia in Pregnancy

• The studies 3, 4, 5 suggest that therapeutic options for Chlamydia trachomatis infections in pregnant women are restricted due to concerns for the fetus.
• Recommended treatments include multi-day treatment with erythromycin, amoxicillin, clindamycin, or single-dose azithromycin, with clinical cure rates ranging from 86% to 95% 3.
• Doxycycline is not recommended for pregnant women due to potential risks to the fetus.

Efficacy of Doxycycline for Chlamydia Treatment

• Studies 6, 7 compare the efficacy of azithromycin and doxycycline for the treatment of rectal Chlamydia infection, with doxycycline showing higher efficacy rates (99.6% vs 82.9%) 6.
• However, these studies were not specifically conducted in pregnant women, and doxycycline is not recommended for use during pregnancy.

Pregnancy Considerations

• The available evidence 3, 4, 5 suggests that azithromycin, erythromycin, amoxicillin, and clindamycin are considered safer alternatives for treating Chlamydia in pregnant women.
• There is no direct evidence to support the use of doxycycline for Chlamydia treatment in pregnant women, and its use is generally contraindicated due to potential fetal risks.