Core Curriculum on Tuberculosis, 2000
Treatment of TB Disease
(See tables 3 -
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.