9.2 Special situations

See references 1 and 5

9.2.1 Women

Pregnant women

All first-line oral drugs can be administered.

Streptomycin is contra-indicated (ototoxic to the fetus).

Rifampicin can increase the metabolism of vitamin K, resulting in clotting disorders. Prophylactic administration of vitamin K to the mother and the neonate is recommended when the mother has received rifampicin during pregnancy:
– For the mother:
phytomenadione (vitamin K) PO: 10 mg/day for the 15 days prior to expected date of delivery
Even with this maternal prevention, the infant still needs prophylactic IM vitamin K to prevent haemorrhagic disease of the newborn.
– For the newborn infant:
phytomenadione (vitamin K) IM: 1 mg as a single dose, the day of birth

All pregnant women should also receive preventive treatment for isoniazid-related peripheral neuropathy (pyridoxine PO: 10 mg/day along with their anti-TB drugs).

Breast-feeding women

Breast-feeding women should routinely receive preventive treatment for isoniazid-related peripheral neuropathy (pyridoxine PO: 10 mg/day along with their anti-TB drugs). In addition, the breast-fed infant should receive pyridoxine PO: 5 mg/day.

Women under contraception

Rifampicin and rifabutin interact with hormonal contraceptives and decreases their efficacy. Patients may choose between: use of medroxyprogesterone IM or barrier methods (diaphragm, condom, UID), or as a last resort, an oral contraceptive containing a high dose of estrogen (50 microgrammes/tab), throughout the course of treatment.

9.2.2 Children

Children should be treated with 2 (HRZE)/4 (HR)2, except for TB meningitis and osteoarticular TB where the treatment is 2 (HRZE)/10 (HR).

Ethambutol is considered safe regardless of child’s age, in particular regarding ocular toxicity6, provided it is correctly dosed at 20 mg/kg/day. It is routinely used in drugsusceptible TB in children.

Streptomycin should be avoided in children because irreversible auditory nerve damage may occur and the injections are painful. Thus, the retreatment regimen is not recommended in children.

Children with TB are often malnourished. Therapeutic feeding should be initiated in children with severe malnutrition. Children not severely malnourished should receive nutritional supplementation with a standard food package or ready-to-use food for at least the first two months of treatment wherever possible.