Use Of Antitb Drugs In Special Situations

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Pregnancy

* Streptomycin during pregnancy can cause permanent deafness in the baby.

* Do not give streptomycin in pregnancy. Use ethambutol instead.

* Isoniazid, rifampicin, pyrazinamide and ethambutol are safe to use.

* Second-line drugs such as fluoroquinolones, ethionamide and protionamide are teratogenic, and should not be used.

Breastfeeding women

* All anti-TB drugs are compatible with breastfeeding.

Renal failure

* Rifampicin, isoniazid and pyrazinamide are safe and can be given in normal dosages. Patients with severe renal failure should receive pyridoxine with isoniazid to prevent peripheral neuropathy.

* Ethionamide and protionamide are also safe.

* The excretion of streptomycin is renal. The excretion of ethambutol and thioacetazone is partly renal.

* Avoid streptomycin and ethambutol if there are alternatives. Otherwise give in reduced doses at less frequent intervals.

* Do not give thioacetazone. The margin between the therapeutic and toxic dose is too narrow.

* The safest regimen to give to patients in renal failure is 2HRZ/4HR.

Liver disease

* Most anti-TB drugs can cause liver damage and therefore care is needed.

* Do not give pyrazinamide because this is the most hepatotoxic anti-TB drug.

* Isoniazid and rifampicin plus one or two non-hepatotoxic drugs, such as streptomycin and ethambutol, can be used for a total treatment duration of eight months.

* If the patient has severe liver damage, an alternative regimen is streptomycin plus isoniazid plus ethambutol in the initial phase followed by isoniazid and ethambutol in the continuation phase with a total duration of 12 months.

* Recommended regimens are 2SRHE/6HE or 2SHE/I0HE.

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