Factors to consider:
(1) trimester of therapy, with risk for malformations greatest in the first trimester
(2) dose if the risk is dose-dependent
(3) choice of macrolide
(4) exclusion of other explanations
Malformations that have been reported to be associated with macrolide therapy during pregnancy:
Fan et al reported risk relative of macrolide vs penicillin therapy to a pregnant woman:
(1) cardiovascular or any major malformations if given during the first trimester
(2) hypospadias or other genital malformations if given during any trimester
(3) erythromycin in the first trimester with any major malformation
Suggestions:
(1) use an alternative antibiotic if possible
(2) do not use in first trimester if possible
(3) use the lowest effective dose for the shortest period of time
