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: http://www.ihatepsm.com/blog/tb-pregnancy-and-lactation
challenges India faces in TB control: http://www.ihatepsm.com/blog/tb-control-faces-daunting-challenges-india
Evolution of Revised National TB Control Program: http://www.ihatepsm.com/blog/evolution-revised-national-tb-control-progr...
5 Components of DOTS strategy: http://www.ihatepsm.com/blog/5-components-dots-strategy
RNTCP Structure: http://www.ihatepsm.com/blog/rntcp-structure
RNTCP Organogram: http://www.ihatepsm.com/blog/rntcp-organogram
Laboratory Network under RNTCP: http://www.ihatepsm.com/blog/laboratory-network-under-rntcp