• acyclovir (Zovirax): Category C— may cause chromosomal breaks at very high concentrations. No data available on risk in breast feeding.
• erythromycin estolate (Ilosone): Category B relative to fetus but contraindicated due to maternal risk of cholestatic hepatitis. No risk in breast feeding. All other erythromycin preparations are considered safe in pregnancy and breast feeding.
• lindane (Kwell): Category C— less toxic alternatives exist. Considered safe in breast feeding
• metronidazole (Flagyl): Category B— contraindicated in first trimester; use in later trimesters if benefits outweigh the risk. Discontinue breast feeding during use—recommend single dose therapy with resumption of breast feeding 12-24 hours after use.
• nitrofurantoin (Macrodantin, Macrobid): Category B— contraindicated in third trimester because of possibility of hemolytic anemia. Avoid during breast feeding if infant at risk for G6PD deficiency; otherwise considered safe.
• Quinolones: ciprofloxacin (Cipro), norfloxacin (Noroxin), ofloxacin (Floxin), levofloxacin (Levaquin): Category C— may cause arthropathy in fetuses, although recent review does not substantiate this risk.
• sulfonamides: Category B in first and second trimesters; Category D in third trimester due to possible kernicterus. Avoid during breast feeding in premature infants and infants with hyperbilirubinemia or G6PD deficiency. Considered safe in full term infants without medical problems.
• tetracyclines/doxycycline (Vibramycin): Category D— may stain teeth and bone.
• trimethoprim/sulfamethoxazole (Bactrim, Septra): Category C in first and second trimesters; Category D in third trimester. See s.y.!foD.§mld§s,, above. Trimethoprim interferes with folic acid metabolism and should be used in the first and second trimesters only if the potential benefits outweigh the risks.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.