Using Tetracycline Antibiotics During Pregnancy

The Specialist Pharmacy Service has released a useful guideline on using tetracycline antibiotics during pregnancy. Published on the 28th of March, 2024, it highlights the following points:

Tetracycline is the medicine of choice if a tetracycline is clinically necessary. This is mainly due to more published evidence of use in breastfeeding and negligible amounts in breast milk. It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.

Short term use (a single course of less than 3 week’s duration) is acceptable for most tetracyclines, with precautionary infant monitoring. Long term use is generally not recommended. However, treatment choice, duration and dose should be primarily based on clinical indications and in line with national and local antimicrobial policy, with suitability in breastfeeding as a secondary consideration.

Infant Effects

The potential effects of the tetracycline antibiotic exposure on the infant need to be considered.

Bone deposition and dental staining

There is a theoretical concern regarding bone deposition of tetracyclines and possible staining of infant’s dental enamel. However, these effects have not been confirmed, and are unlikely during short term use.

As a precaution, prolonged or repeated courses should be avoided where possible during breastfeeding.

Oral and gut microflora

Exposure to antimicrobials can affect the infant’s natural balance of microflora. In rare cases, antibiotic exposure has disturbed this balance and caused gastrointestinal disturbances or candidiasis. These effects are generally mild and resolve upon treatment discontinuation.

Treatment of infant infections

There is no conclusive information on whether the concentrations the infant is exposed to through breast milk are enough to be bactericidal or cause bacterial resistance.

If the infant needs treatment themselves with an antibiotic, they should receive the appropriate infant therapeutic dose, regardless of concomitant exposure through breast milk.

Hypersensitivity

There is a theoretical risk of hypersensitivity in the infant after exposure to antibiotics through breast milk. Foetal exposure to antibiotics through the placenta may cause sensitisation. Further exposure may result in allergic reactions, even from the negligible quantities seen in breast milk.

As a precaution, the infant should be monitored for signs of hypersensitivity which includes rashes and breathing problems.

Further details

The guideline goes on to provide specific in formation in relation to Tetracycline, Demeclocycline, Doxycycline, Minocycline and Oxytetracycline. You may find the details here.

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