Treatment of tuberculosis during pregnancy

The pregnant woman with tuberculosis who requires treatment presents a therapeutic dilemma; therefore, we reviewed all available literature on pregnant women treated with isoniazid (INH), ethambutol (EMB), rifampin (RMP), or streptomycin (SM) and report here on the relative safety of these drugs and whether the risk of teratogenesis justifies abortion on medical grounds. Other than the ototoxicity of SM, none of these drugs in normal dosages are proved teratogens to human fetuses. We recommend the use of INH in combination with EMB for a pregnant woman with tuberculosis, if the disease is not extensive. If a third drug is warranted, then RMP could be added. Because of its ototoxicity, SM should not be used, unless RMP is contraindicated or proves unsatisfactory. Routine therapeutic abortion is not medically indicated for a pregnant woman who is taking first-line antituberculosis drugs.