Multidrug-Resistant Tuberculosis during Pregnancy: Two Case Reports and Review of the Literature
Table 1
Safety of MDR-TB medicines during pregnancy.
Medication
Safety class
Comments
Ethambutol
B
Experience in gravid patients suggests safety.
Pyrazinamide
C
Use with caution. Most references suggest it is safe to use.
Aminoglycosides
Streptomycin
D
Avoid use. Documented toxicity to developing foetal ear. Risks and benefits must be carefully considered. Avoid use when possible.
Kanamycin
D
Amikacin
D
Capreomycin
C
Fluoroquinolones
Levofloxacin
C
Use with caution. No teratogenic effects seen in humans when used for short periods of time (2–4 weeks). Associated with permanent damage to cartilage in weight-bearing joints of immature animals. Experience with long-term use in gravid patients is limited, but, given bactericidal activity, benefits may outweigh risks.
Moxifloxacin
C
Gatifloxacin
C
Ethionamide/prothinamide
C
Avoid use. Teratogenic effects observed in animal studies; significantly worsens nausea associated with pregnancy.
PAS
C
Causes fatal diarrhea.
Cycloserine/terizidone
C
Significant experience in gravis patients: animal studies have documented toxicity.
Amoxicillin/clavulanic acid
B
Compatible with breast-feeding. Causes fetal necrotizing enterocolitis.
Rifabutin
B
Unknown compatibility with breast-feeding.
Linezolid
C
Not yet approved for tuberculosis treatment; reduced efficacy with rifampicin.
