2634 Tuberculosis and pregnancy

The indications for treatment of active tuberculosis in pregnant women are no different from those for non-pregnant women. Transmission and infection arc felt to be the same as in the nonpregnant individual, and pregnancy does not seetn to influence the course of the disease (Laibl 2005, Tripathy 2002. Espinal 1996).

Untreated tuberculosis represents a greater hazard to the mother and her fetus than does the treatment of the disease (Bothamley 2001, Raju 1998, Brost 1997). There are slight differences in the recommendations of the different organizations in the world, such as the WHO, the International Union against Tuberculosis and Lung Disease (1UATLD), and several national organizations (Frieden 2003). Treatment considerations depend on disease status and drug resistance. Some treatment schedules recommend delaying preventive therapy until after delivery in pregnant women with only a positive tuberculin skin test (PPD) but a negative chest radiograph, unless they have a high risk of progressing to active disease (for example, HIV patients, diabetics, recent converters, and those who are close contacts of a person with an active disease). For the treatment of active tuberculosis, isoniazide (INH), rifampicin, and ethambutol arc considered to be the first-line antituberculous drugs during pregnancy; a regimen includingpyrazinamide for the first 2 months can be considered. A particular problem is the increasing incidence of single-and multidrug-resistant tuberculosis (MDRTB). Therefore, treatment should always consist of at least two, but usually three or more, drugs. Pregnant women with MDR-TB may also require second-line antituberculous drugs; the necessity for treatment should be weighed against the risk for the fetus on an individual base (Lalbl 2005, Frieden 2003, Shin 2003, Tripathy 2002, Bothamley 2001, Raju 1998, Brost 1997). A major cause of tuberculosis resistance and treatment failure is medication non-compliance. Because of the seriousness of tuberculosis in pregnancy, the importance of daily intake should be emphasized and this should be supervised if necessary.

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