American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which of the following is an alternative treatment for Rocky Mountain spotted fever in pregnant women?

Doxycycline
Chloramphenicol
Cephalexin
Trimethoprim-sulfamethoxazole

The correct answer is: Chloramphenicol

Chloramphenicol is recognized as an alternative treatment for Rocky Mountain spotted fever in pregnant women. This is primarily due to safety concerns surrounding the use of doxycycline, which is the first-line treatment for the disease but is contraindicated during pregnancy because it can affect fetal development, particularly bone and teeth formation. Chloramphenicol has a well-established safety profile in pregnancy and is effective against the bacteria that cause Rocky Mountain spotted fever, Rickettsia rickettsii. It penetrates well into tissues and can help manage the infection when doxycycline is not an option. The other options are less favored or unsuitable for treating Rocky Mountain spotted fever. While doxycycline is highly effective, its use is avoided in pregnancy. Cephalexin is a cephalosporin antibiotic that is not effective against Rickettsial infections. Trimethoprim-sulfamethoxazole, although it has some activity against certain infections, is not specifically recommended for Rocky Mountain spotted fever and may carry risks in pregnancy, making chloramphenicol the preferred alternative in this scenario.