Paper II — 2013 September (Supplementary) (2010 Scheme) — Q2
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Paper II
2013 September (Supplementary) (2010 Scheme) · 40 marks · 120 min
Question
Read the clinical problem and answer the following questions. A 20 years old pregnant woman
developed a mild upper respiratory tract infection .She was given cap. Tetracycline 250mg thrice
daily for three days.
(a) Comment on the treatment for a mild bacterial infection. 2 mark(s)
(b) Comment on the use of tetracycline in pregnancy. 2 mark(s)
(c) If it was a severe infection, what will be your choice of antibiotic in a pregnant woman. 2 mark(s)
Q26 marksEssays
Answer
(a) Comment on the treatment
Most mild upper respiratory tract infections are viral and self-limiting, not requiring antibiotics
If a bacterial cause is suspected/confirmed, a narrow-spectrum, safe antibiotic appropriate to the likely organism should be chosen at the correct dose and duration
Tetracycline is an inappropriate choice here — it is contraindicated in pregnancy, so prescribing it to a pregnant woman for a mild infection represents a prescribing error irrespective of whether antibiotics were indicated at all
(b) Use of tetracycline in pregnancy
Tetracyclines are contraindicated in pregnancy
They cross the placenta and get deposited in developing fetal bones and teeth (chelation with calcium) → discolouration/staining of deciduous teeth and inhibition of bone growth in the fetus
Also hepatotoxic to the mother, particularly with high IV doses in pregnancy
(c) Choice for a severe infection in pregnancy
Penicillins (e.g., Amoxicillin) — safe in pregnancy, first choice for susceptible organisms
Cephalosporins — safe alternative, especially in penicillin allergy in select cases (with caution) or Erythromycin (macrolide, safe in pregnancy) as the alternative in true penicillin allergy
Avoid tetracyclines, fluoroquinolones, and aminoglycosides (except when specifically indicated and unavoidable) in pregnancy
