TB disease discovered during pregnancy should be treated without delay. Because of
the risk for tuberculosis to the fetus, treatment of TB in pregnant women should be initiated whenever
the probability of maternal disease is moderate to high. A minimum of two sputum samples should be submitted
for examination. The outcome of the AFB cultures and drug susceptibility test results will determine the regimen for continuation of treatment.
Drug Treatment in
Pregnancy⌃
The
initial treatment regimen usually consists of INH, RIF and EMB; consideration should be given to including PZA.
Although detailed teratogenicity data are not available, PZA can probably be used safely during pregnancy and is
recommended for use by the World Health Organization (WHO) and the International Union Against Tuberculosis and
Lung Disease (IUATLD). In some U.S. jurisdictions, PZA has not been routinely recommended. PZA should be
included in the initial regimen for women living with HIV and for HIV seronegative women who are thought to be at increased risk for drug resistant TB. If PZA is not included in the initial treatment regimen, the minimum duration of therapy for drug-susceptible TB is 9 months.
Pyridoxine (Vitamin B6) (25 mg/d) is recommended for all pregnant women taking INH.
Avoid: Aminoglycosides (e.g., streptomycin, amikacin) are contraindicated for all
pregnant women because of potential adverse effects on the fetus. Fluoroquinolones (e.g., levofloxacin, moxifloxacin) have been associated
with arthropathies in young animals; therefore, they should be avoided if possible, in pregnant women.
Breast Feeding⌃
The small concentrations of first line TB drugs in breast milk do not have a toxic effect on nursing newborns
and breast feeding should not be discouraged. Conversely, drugs in breast milk should not be considered
to serve as effective treatment for disease or as treatment of LTBI in a nursing infant.
Table 17. Use of Anti-TB Medications in Special Situations: Pregnancy, Tuberculous Meningitis
and Renal Failure
Safety in Pregnancy i
Safe i
Central Nervous System Penetration i
Good (20-100%)
Dosage in Renal Insufficiency i
No change
Safety in Pregnancy i
Safe (isolated reports of malformation)
Central Nervous System Penetration i
Fair, Inflamed meninges (10-20%)
Dosage in Renal Insufficiency i
No change
Safety in Pregnancy i
Caution i
Central Nervous System Penetration i
Good (75-100%)
Dosage in Renal Insufficiency i
Decrease dose/ Increase interval
Safety in Pregnancy i
Safe
Central Nervous System Penetration i
Inflamed meninges only (4-64%)
Dosage in Renal Insufficiency i
Decrease dose/ Increase interval
Safety in Pregnancy i
Avoid
Central Nervous System Penetration i
Poor i
Dosage in Renal Insufficiency i
Decrease dose/ Increase interval i
Safety in Pregnancy i
Avoid
Central Nervous System Penetration i
Poor
Dosage in Renal Insufficiency i
Decrease dose/ Increase interval i
Safety in Pregnancy i
Do not use
Central Nervous System Penetration i
Fair (5-10%) Inflamed meninges (50-90%)
Dosage in Renal Insufficiency i
Decrease dose/ Increase interval i
Safety in Pregnancy i
Avoid
Central Nervous System Penetration i
Good (100%)
Dosage in Renal Insufficiency i
No change
Safety in Pregnancy i
Avoid
Central Nervous System Penetration i
Good (50-100%)
Dosage in Renal Insufficiency i
Decrease dose/ Increase interval
Safety in Pregnancy i
Safe
Central Nervous System Penetration i
Inflamed meninges only (50-100%)
Dosage in Renal Insufficiency i
Incomplete data
Safety in Pregnancy i
Avoid
Central Nervous System Penetration i
Unknown
Dosage in Renal Insufficiency i
Probably no change
Safe: Drug has not been demonstrated to have teratogenic effects.
Avoid: Limited data on safety or for aminoglycosides associated with hearing impairment and/or other toxicity.
Do Not Use: Associated with premature labor, congenital malformations or teratogenicity.
