Obstetrics and Gynecology Clinics of North America
THE MATERNAL AND FETAL EFFECTS OF TUBERCULOSIS THERAPY
Section snippets
Isoniazid
Isoniazid is the drug of choice for tuberculosis prophylaxis and treatment of active disease during pregnancy. It is an inexpensive medication that is easily administered and highly active against many strains of mycobacterium. The side effect profile includes cutaneous hypersensitivity, hepatitis, and peripheral neuropathy. Isoniazid also seems to potentiate the action of anticonvulsants, including phenytoin, ethosuximide, and carbamazepine.
Peak blood concentrations of 5 μg/mL occur within 1
CONSIDERATIONS FOR THERAPY DURING PREGNANCY
Once a diagnosis of tuberculosis is made, it is important to begin aggressive therapy and to observe the pregnant woman during both the antepartum and postpartum period to ensure compliance with medical therapy. Although the CDC has proposed a variety of regimens for the initial treatment of children and adults11 (including daily or two to three times per week therapy options), these regimens cannot be used during pregnancy because of potential (streptomycin) and unknown (pyrazinamide) fetal
THERAPY IN THE IMMUNOCOMPROMISED WOMAN
The overall prevalence of tuberculosis coinfection in HIV-infected individuals ranges from 5% to 35%.76 The risk for active disease increases 8% annually in HIV-infected individuals with a positive tine test in comparison with a 10% lifetime risk in immunocompetent individuals.18, 61 The progression to active and sometimes fulminate disease can occur within months of exposure in HIV-positive individuals. A limited number of reports describe coinfection with tuberculosis in HIV-positive pregnant
SUMMARY
Tuberculosis can cause significant morbidity in the pregnant woman, fetus, and members of the community. The first-line agents suggested by the CDC for use during pregnancy (isoniazid, rifampin, and ethambutol) seem to have minimal risk of induced congenital anomalies. Maternal morbidity associated with therapy does not seem increased above rates observed in the nonpregnant population. Education of the patient concerning the potential adverse side effects may decrease maternal morbidity.
References (80)
- et al.
Changes in cortisol metabolism following rifampicin therapy
Lancet
(1974) - et al.
Aminoglycoside ototoxicity in the chick (Gallus domesticus) inner ear. I. The effects of kanamycin and netilmycin on the basilar papilla
Am J Otolaryngol
(1983) - et al.
Ethambutol in pregnancy: Observations on embryogenesis
Chest
(1974) - et al.
Rifampicin in pregnancy
Lancet
(1977) - et al.
Tuberculosis complicated by pregnancy
Am J Obstet Gynecol
(1973) - et al.
[Ototoxic effect of BB-K8 administered to pregnant guinea pigs on development of the inner ear of intrauterine litters.]
Jpn J Antibiotic
(1977) Pulmonary disease in pregnancy
Technical Bulletin Number 224
(June 1996)Treatment of tuberculosis and tuberculosis infection in adults and children
Am Rev Respir Dis
(1986)Rifampicin: A review
Drugs
(1971)- et al.
Tuberculosis in patients with HIV infection
N Engl J Med
(1991)
The effect on the rat of transplacentally acquired tetracycline
Biol Neonate
Development postnatal des descendants issus de meres traitees par la streptomycine au cours de la gestation chez la souris
CR Soc Biol (Paris)
Placental transfer of isonicotinic acid hydrazide
Gynecologia
Initial therapy for tuberculosis in the era of multidrug resistance: Recommendations of the advisory council for the elimination of tuberculosis
MMWR
USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: A summary
MMWR
Tuberculosis morbidity—United States, 1995
MMWR
Impact of HIV protease inhibitors on the treatment of HIV-infected tuberculosis patients with rifampin
MMWR
The transfer of drugs and other chemicals into human milk
Pediatrics
Streptomycin in pregnancy: Effect on the fetal ear
BMJ
Experimental teratology in the monkey
Toxicol Appl Pharmacol
An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus
N Engl J Med
The search for teratogenic activity of some tuberculostatic drugs
Diss Pharm Pharmacol
Streptomycin ototoxicity in the unborn child
S Afr Med J
Mycobacterial infections
The effect of tuberculostatics on the fetus: An experimental production of congenital anomaly in rats by ethionamide
Proc Congenital Anom Res Assoc Jpn
[Antibiotic action on the embryonic development of the fetuses of amphibians.]
Eksp Med Morfol
The placental transfer of kanamycin during late pregnancy
Obstet Gynecol
Isoniazid therapy in relation to later occurrence of cancer in adults and in infants
BMJ
Streptomycin: Absorption, diffusion, excretion and toxicity
Am J Med Sci
Antituberculosis drugs and breast-feeding
Arch Intern Med
Intrauterine ototoxicity: A case report and review of the literature
J Natl Med Assoc
Nonteratogenicity of isoniazide in mice
Teratology
Metabolism and kinetics pharmacokinetics of the antibiotic rifampin
Drug Metab Rev
Zur Frage der intrauterinen streptomycin schadigung
Schweiz Med Wochenschr
Study of teratogenic activity of trifluoperazine, amitriptyline, ethionamide and thalidomide in pregnant rabbits and mice
Proc Eur Soc Study Drug Toxic
Existe-t-il une surdete congentale axquise due a la streptomycine?
Ann Otolaryngol
The inhibition of protein-lysine 6-oxidase by various lathryogens: Evidence for two different mechanisms
Biochem J
Congenital defects among children born to women under supervision or treatment for pulmonary tuberculosis
Br J Prev Soc Med
Cited by (44)
Validation and application of a quantitative LC-MS/MS assay for the analysis of first-line anti-tuberculosis drugs, rifabutin and their metabolites in human breast milk
2022, Journal of Chromatography B: Analytical Technologies in the Biomedical and Life SciencesCitation Excerpt :Previous studies indicated that concentrations of first-line TB drugs in breast milk were lower than the recommended therapeutic doses for infants [2–4]. Although several studies report low transfer rates of some TB drugs to breast milk [2–7], there are no published bioanalytical methods for first-line TB drugs, including rifabutin and their metabolites in breast milk.. In a study by Singh et al. [7], quantification of isoniazid in breast milk was reported but the method used was validated for the determination of isoniazid in serum, not breast milk [8].
Factors Leading to Suboptimal Therapy and the Emergence of Drug and Multidrug Resistance
2017, Infectious Diseases, 2-Volume SetMaternal Sepsis
2013, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :Even though tuberculin skin test or interferon-γ release assay testing are standard for HIV-infected gravidas, a chest radiograph also should be obtained. Many people advocate delaying treatment in gravidas until after delivery, but in the HIV-infected gravid population, the recommendation is to treat.62,63 Latent TB proceeds to pulmonary TB in 8% of these cases (as opposed to 1%–2% in the general population).
Tuberculosis in special populations
2011, Enfermedades Infecciosas y Microbiologia ClinicaAntituberculosis agents
2010, Infectious Diseases: Third EditionPreparation and antitubercular activities in vitro and in vivo of novel Schiff bases of isoniazid
2009, European Journal of Medicinal ChemistryCitation Excerpt :This strategy for drug design has been proposed as a vehicle for controlled study of the growth cycle of the pathogen, as well as a means of augmenting fundamental drug activity [24–27]. Previous work on several members of this class, particularly the aromatic derivatives, had been carried out some years ago and had demonstrated good activities by the methods then available [28–37]. These compounds have continued to attract the attention of medicinal chemists up to the present day [38–43].
Address reprint requests to Brian C. Brost, MD, Department of Obstetrics and Gynecology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425–2233
- *
Department of Obstetrics and Gynecology, Keefler Air Force Base, Biloxi, Mississippi (BCB); and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina (RBN)