Recommendations for the initial treatment of tuberculosis in pregnant women include the drugs isoniazid (INH) and rifampin. If resistance to INH seems likely, ethambutol should also be added.
Isoniazid has not been shown to cause birth defects or other fetal harm in humans. Neither has its use been demonstrated to cause birth defects in animal studies, although the drug may cause embryo death in rats and rabbits and can cause lung cancer in specific strains of mice. It is FDA category C. When INH is prescribed during pregnancy, pyridoxine (Vitamin B6) should be concurrently taken.
Rifampin causes birth defects in rodents. Its effect on the human fetus, either alone or in combination with other antituberculous drugs, is unknown. Rifampin is also FDA category C.
Ethambutol is not known to produce adverse effects on the human fetus, although data is limited, and the drug’s effects when it is used in combination with other tuberculosis drugs is not known.
Streptomycin, another antituberculous agent, should not be used during pregnancy, since it cam cause adverse fetal effects. Other antituberculous drugs should also be avoided because their effects on the fetus have not been adequately evaluated
......inh(1st option) followed by rifampicin(2nd best option)...... its from journal collection of my mom ...hope it will help you too
Drug Name
Rifampin (Rifadin) -- Bactericidal for M tuberculosis. Penetrates well into all body fluids including CSF. For use in combination with at least one other antituberculous drug. Inhibits RNA synthesis in bacteria by binding to beta subunit of DNA-dependent RNA polymerase, which, in turn, blocks RNA transcription. Cross-resistance may occur.
Adult Dose 600 mg PO/IV qd
Pediatric Dose 10-20 mg/kg PO/IV qd; not to exceed 600 mg/d
Contraindications Documented hypersensitivity
Interactions Induces microsomal enzymes, which may decrease effects of acetaminophen, oral anticoagulants, barbiturates, benzodiazepines, beta-blockers, chloramphenicol, oral contraceptives, corticosteroids, mexiletine, cyclosporine, digitoxin, disopyramide, estrogens, hydantoins, methadone, clofibrate, quinidine, dapsone, tazobactam, sulfonylureas, theophyllines, tocainide, and digoxin; blood pressure may increase with coadministration of enalapril; coadministration with isoniazid or pyrazinamide may result in higher rate of hepatotoxicity than with either agent alone (discontinue one or both agents if alterations in serum transaminases occur)
Pregnancy C - Safety for use during pregnancy has not been established. Precautions In adults and those at risk, obtain CBCs and baseline clinical chemistries prior to and throughout therapy; in liver disease, weigh benefits against risk of further liver damage; interruption of therapy and high-dose intermittent therapy are associated with thrombocytopenia that is reversible if therapy is discontinued as soon as purpura occur; if treatment is continued or resumed after appearance of purpura, cerebral hemorrhage or death may occur; orange discoloration of secretions or urine may occur; staining of contact lenses may occu
Isoniazid (Laniazid, Nydrazid) -- Commonly referred to as INH. Best combination of effectiveness, low cost, and minor adverse effects. First-line drug unless known resistance or another contraindication is present. Therapeutic regimens of <6 mo demonstrate unacceptably high relapse rates. Coadministration of pyridoxine is recommended if peripheral neuropathies secondary to INH therapy develop. Prophylactic doses of 6-50 mg of pyridoxine daily are recommended in some populations.
Adult Dose 5 mg/kg PO qd (usually 300 mg/d) and 10 mg/kg qd or divided bid in patients with disseminated disease; not to exceed 300 mg/d
DOT: 15 mg/kg twice weekly; not to exceed 900 mg/d
Pediatric Dose 10-20 mg/kg PO qd; not to exceed 300 mg/d
Contraindications Documented hypersensitivity; previous INH-associated hepatic injury or other severe adverse reactions
Interactions Higher incidence of INH-related hepatitis can occur with alcohol ingestion on daily basis; aluminum salts may decrease INH serum levels (administer 1-2 h before taking aluminum salts); may increase anticoagulant effects with coadministration; may inhibit metabolic clearance of benzodiazepines; carbamazepine toxicity or INH hepatotoxicity may result from concurrent use (monitor carbamazepine concentrations and liver functions); coadministration with cycloserine may increase CNS adverse effects (eg, dizziness); acute behavioral and coordination changes may occur with coadministration of disulfiram; coadministration with rifampin after halothane anesthesia may result in hepatotoxicity and hepatic encephalopathy; may inhibit hepatic microsomal enzymes and increase toxicity of hydantoin
Pregnancy C - Safety for use during pregnancy has not been established. Precautions Monitor patients with active chronic liver disease or severe renal dysfunction; periodic ophthalmologic examinations during INH therapy are recommended even when visual symptoms do not occur
Streptomycin -- For treatment of susceptible mycobacterial infections. Use in combination with other antituberculous drugs (eg, INH, ethambutol, rifampin).
Adult Dose 1 g IM qd
2 times/wk dosing: 15 mg/kg/d IM; not to exceed 1 g/d
3 times/wk dosing: 25-30 mg/kg/d IM; not to exceed 1.5 g/d
Pediatric Dose 2 times/wk dosing: 20-40 mg/kg/d IM; not to exceed 1 g/d
3 times/wk dosing: 25-30 mg/kg/d IM; not to exceed 1.5 g/d
Contraindications Documented hypersensitivity; non–dialysis-dependent renal insufficiency
Interactions Nephrotoxicity may be increased with aminoglycosides, cephalosporins, penicillins, amphotericin B, and loop diuretics
Pregnancy D - Unsafe in pregnancy
Precautions Narrow therapeutic index; not intended for long-term therapy; caution in patients with renal failure who are not on dialysis; caution with myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission
Ethambutol (Myambutol) -- Diffuses into actively growing mycobacterial cells, such as tubercle bacilli. Impairs cell metabolism by inhibiting synthesis of one or more metabolites, which in turn causes cell death. No cross-resistance demonstrated.
Mycobacterial resistance is frequent with previous therapy. Use in these patients in combination with second-line drugs that have not been previously administered.
Administer q24h until permanent bacteriologic conversion and maximal clinical improvement are observed. Absorption is not significantly altered by food.
Adult Dose No previous antituberculous therapy: 15 mg/kg (7 mg/lb) PO qd
Previous antituberculous therapy: 25 mg/kg (11 mg/lb) PO qd
Pediatric Dose <13 years: Not recommended
>13 years: Administer as in adults
Contraindications Documented hypersensitivity; optic neuritis (unless clinically indicated)
Interactions Aluminum salts may delay and reduce absorption (give several hours before or after ethambutol dose)
Pregnancy B - Usually safe but benefits must outweigh the risks. Precautions Reduce dose in impaired renal function; may have reversible visual adverse effects if promptly discontinued; monitor for visual acuity and color vision; avoid administration in children if unable to test vision
with the above explanation i would go for the answer Ethambutol!!!
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