Are there any special concerns regarding antibiotic therapy in pregnant women with regard to bioterrorism?
Pregnant women are considered a “vulnerable” population in the setting of a bioterror attack. Not only are clinicians concerned about providing appropriate therapy to the woman, but they also must consider any effects that therapy may have on the fetus. In the bioterrorism setting, ciprofloxacin and doxycycline are recommended antibiotic treatments for anthrax, plague, and tularemia. Generally, ciprofloxacin is not recommended for use in pregnant women due to the potential for fetal arthropathy; however, no studies have been performed confirming the occurrence of this adverse event in this patient population. In addition, doxycycline is a pregnancy category D medication; pregnant women receiving this medication have reported hepatotoxicity and retarded skeletal growth has been observed in the fetus. Pregnant women receiving doxycycline should have periodic liver function monitoring. Despite these concerns, the Working Group on Civilian Biodefense states that the benefits of these thera
