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A 30-year-old pregnant female develops a UTI that is caused by Chlamydia trachomatis. Of the following, which is the best agent to use in this patient?

a. Tetracycline
b. Levofloxacin
c. Gentamycin
d. Erythromycin
e. Sulfamethoxazole-trimethoprim


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The answer is d.

Erythromycin is safe to use in pregnancy and is effective against Chlamydia. Levofloxacin is contraindicated in pregnancy because animal studies have identified that cartilage erosion can occur during growth. Chlamydia are not sensitive to gentamycin, however, it probably should not be used in pregnancy because of potential nephro and ototoxicity. Tetracycline may cause tooth enamel dysplasia and problems with bone during fetal development. Sulfamethoxazole-trimethoprim has severe consequences, particularly in the newborn, because it displaces bilirubin from albumin, which is then deposited in the brain causing a condition referred to as kernicterus.