14.3.4  Anti-TB drug treatment in special situations

Pregnancy

Be sure to ask women patients whether they are pregnant. Most anti-TB drugs are safe for use in pregnancy, with the exception of streptomycin, because this can cause permanent deafness in the baby. Pregnant women who have TB must be treated, so ethambutol is used instead of streptomycin. Refer pregnant TB patients to a clinician who can prescribe the appropriate anti-TB drug regimen.

Oral contraception

Rifampicin interacts with oral contraceptive medications with a risk of decreased protection against pregnancy. A woman who takes the oral contraceptive pill (which you’ll probably know is medication used for preventing pregnancy) may choose between two options while receiving treatment with rifampicin, following consultation with a clinician. She could either take an oral contraceptive pill containing a higher dose of oestrogen (50 µg), or she could use another form of contraception. You should be in a position to give advice on the options for women in this situation; the Module on Family Planning will give you more guidance on topics such as this.

Breastfeeding

A breastfeeding woman who has TB can be treated with the regimen appropriate for her disease classification and previous treatment. The mother and baby should stay together and the baby should continue to breastfeed in the normal way.

The benefits of breastfeeding to the baby are greater than the risk of getting TB from the mother, or diarrhoeal diseases when the baby is fed with animal or formula milk using a feeding bottle. However, you need to advise the mother to take her child for screening for TB to a higher health facility. If the baby is not infected with TB, he or she will be provided with isoniazide preventive therapy. It is also important that the mother cover her mouth during coughing or sneezing, to prevent TB transmission to the baby.