I Hate PSM

TB in Pregnancy and Lactation

Before initiating treatment for TB in women, she should be asked about current or planned pregnancy

  • EXCEPT Streptomycin, all first line anti –TB drugs are safe for use in pregnancy
    • Streptomycin is ototoxic to the fetus and should not be used during pregnancy

In case of MDR –TB: Test for pregnancy

  • If not pregnant advised to use birth control

    • OCPs should be avoided
    • Use of barrier methods or IUD is recommended

  • If pregnant:

    • ≤ 20 wks.: advise MTP and treat after MTP
    • If unwilling for MTP, start modified regimen for <20 wk.

Modified regimen for ≤ 20 wk. preg:

  • If ≤ 12 wks.: Omit Kanamycin and Ethionamid; add PAS till delivery

  • If > 12 wks.: Omit Kanamycin; add PAS till Delivery

  • 20 wks.: start modified regimen for > 20 wk. pregnancy

Modified regimen for > 20 wk. preg:

  • Omit Kanamycin; add PAS till Delivery

  • Replace PAS with kanamycin after delivery

After delivery:

  • Breast feeding woman should receive a full course of TB treatment
    • Breast feeding has to be continued
    • Baby: actively R/O TB
    • Give 6 months of INH prophylaxis
    • BF is NOT discouraged
    • Mother advised about cough hygiene – cover mouth and nose while coughing
    • BCG vaccination after INH prophylaxis is over
    • Both mother and breastfed infant should be supplemented with vitamin B6 (pyridoxine) if on INH is being given (pyridoxine dose: 5mg/day)

Refernce: Park's Textbook of Preventive and Social Medicine, 24th Edition

TB in pregnancy and lactation: TB in Pregnancy and Lactation
challenges India faces in TB control: TB Control Faces Daunting Challenges in India
Evolution of Revised National TB Control Program: Evolution of Revised National TB Control Program (RNTCP)

5 Components of DOTS strategy: 5 Components of DOTS strategy
RNTCP Structure: RNTCP Structure
RNTCP Organogram: RNTCP Organogram

Laboratory Network under RNTCP: Laboratory Network under RNTCP