Rifampin Exposure in Pregnant and Nonpregnant Women With Tuberculosis in India

Area of Science:

• Pharmacology
• Infectious Diseases
• Maternal Health

Background:

• Tuberculosis (TB) remains a significant global health challenge, particularly in pregnant women.
• Optimizing anti-TB drug regimens during pregnancy is crucial for maternal and infant outcomes.
• Rifampin is a cornerstone of TB treatment, but its pharmacokinetics in pregnancy are not well understood.

Purpose of the Study:

• To evaluate and compare rifampin pharmacokinetics in pregnant and non-pregnant women with active tuberculosis in India.
• To determine the proportion of pregnant women achieving target rifampin concentrations across different trimesters.
• To inform potential adjustments to rifampin dosing strategies during pregnancy.

Main Methods:

• Prospective cohort study design.
• Inclusion of adult women diagnosed with active tuberculosis in India.
• Pharmacokinetic sampling and analysis of rifampin concentrations throughout pregnancy and postpartum.

Main Results:

• Pregnant women exhibited significantly lower rifampin drug exposure compared to non-pregnant controls.
• Fewer than 20% of pregnant participants achieved target rifampin concentrations at any stage of gestation.
• Drug exposure appeared to decrease with advancing pregnancy, suggesting potential dose-related efficacy concerns.

Conclusions:

• Current standard rifampin dosing may lead to sub-therapeutic drug levels in pregnant women with tuberculosis.
• There is a critical need for dedicated pharmacokinetic studies to establish optimal rifampin dosing during pregnancy.
• Revised dosing guidelines for rifampin in pregnancy are essential to ensure effective tuberculosis treatment and prevent treatment failure or relapse.