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U.S. Department of Health and Human Services


Core Curriculum on Tuberculosis, 2000

Chapter 7
Treatment of TB Disease

(See tables 3 - 7)

Pregnant or Lactating Women

Pregnant women with TB must be given adequate therapy as soon as TB is suspected. The preferred initial treatment regimen is isoniazid, rifampin, and ethambutol (ethambutol may be excluded if primary isoniazid resistance is unlikely). Streptomycin should not be used because it has been shown to have harmful effects on the fetus. In addition, pyrazinamide should not be used routinely because its effect on the fetus is unknown. Because the 6-month treatment regimen cannot be used, a minimum of 9 months of therapy should be given. To prevent peripheral neuropathy, it is advisable to give pyridoxine (vitamin B 6 ) to pregnant women who are taking isoniazid.

The small concentrations of TB drugs in breast milk do not have a toxic effect on nursing newborns, and breast-feeding should not be discouraged for women undergoing anti-TB therapy. Similarly, drugs in breast milk should not be considered effective treatment for disease or infection in a nursing infant.

TB Treatment for HIV-Positive Pregnant Women
HIV-positive pregnant women who have a positive M. tuberculosis culture or who are suspected of having TB disease should be treated without delay. Choices of TB treatment regimens for HIV-positive pregnant women are those that include a rifamycin. Although the routine use of pyrazinamide during pregnancy is not recommended in the United States because of inadequate teratogenicity data, the benefits of a TB treatment regimen that includes pyrazinamide for HIV-positive pregnant women outweigh the potential pyrazinamide-related risks to the fetus. Aminoglycosides (e.g, streptomycin, kanamycin, amikacin), capreomycin, and fluroquinolones are contraindicated for all pregnant women because of adverse effects on the fetus.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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