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Treatment of tuberculosis caused by multidrug-resistant strains of Mycobacterium tuberculosis during pregnancy

According to a report published in the journal Clinical Infectious Diseases, women with tuberculosis caused by strains of multidrug-resistant mycobacteria (multidrug-resistant tuberculosis - MDR-TB) can be treated during pregnancy without threatening the fetus. Pregnancy may not be a contraindication for the treatment of tuberculosis caused by multidrug-resistant strains, although undoubtedly ineffective treatment of MDR-TB during pregnancy can have a high incidence both in the mother than in the baby.

As a rule, second-line anti-tuberculosis drugs or reserve drugs such as ethionamide, protionamide, cycloserine, capreomycin, kanamycin, amikacin, rifabutin, ciprofloxacin, ofloxacin, acid paraminosalicylic acid are used to treat tuberculosis caused by multidrug-resistant strains of mycobacteria. The use of most second-line anti-tuberculosis drugs during pregnancy is contraindicated and, if necessary, their appointment should consider the possibility of terminating the pregnancy.

Doctors from the United States report on the treatment experience of 7 women with MDR-TB during pregnancy, as well as the results of the observation of six postpartum patients and their children during the first few years of their lives. According to the results of the observation, all the women gave birth at term. Six children were observed over (average) 3.7 years. The fate of a child is unknown, as it has not been observed by doctors due to the mother's death from postoperative complications.

Researchers report all children were normal weights, had no visible physical developmental defects and perinatal complications, despite the fact that four women took second-line anti-tuberculosis drugs in the first trimester of pregnancy and three other patients in the second and third trimesters..

None of the infants in the neonatal period showed symptoms of infection caused by Mycobacterium tuberculosis, however, one child later developed primary multidrug-resistant tuberculosis after contact with a parent of the mother in whom active pulmonary tuberculosis was diagnosed.

Unlike this child, who had slight weight gain and stunted growth, the other children had normal indicators of physical development and no neurological symptoms were recorded. None of the children showed reliable signs of late onset toxicity.

According to the researchers, children born to mothers with MDR-TB should be closely monitored for 3 to 4 years. Children under the age of four have the highest risk of developing a disseminated form of the disease, therefore they should undergo a thorough clinical examination at least every 6 months to identify the signs and symptoms of tuberculosis or delays in physical development. In this study, a tuberculin skin test was performed immediately after birth and at the age of six months.

Researchers note that to establish the safety of using second-line anti-tuberculosis drugs during pregnancy, additional studies are needed. Pregnant women with MDR-TB may be able to receive anti-TB drugs in the future without terminating the pregnancy.