What is the recommended TB regimen for pregnant patients?

• A. Typically includes isoniazid, rifampin, ethambutol, and sometimes pyrazinamide; avoid streptomycin; monitor liver function; dosing is adjusted for pregnancy.
• B. Exclude ethambutol
• C. Use streptomycin in pregnancy
• D. Only rifampin is used in pregnancy

Answer: (A)

In pregnancy, the aim is to treat TB effectively while minimizing risk to the fetus, so the regimen of choice includes isoniazid, rifampin, ethambutol, and often pyrazinamide. This combination is highly effective, helps shorten therapy, and has a safety profile that is generally acceptable for both mother and baby. Streptomycin is avoided during pregnancy because it can cause fetal hearing loss, a serious concern that makes it unsuitable in most cases. Isoniazid is given with vitamin B6 (pyridoxine) to prevent neuropathy, and all drugs are monitored for liver toxicity since pregnancy can influence how the body handles medications. Pyrazinamide is included in many guidelines because it helps shorten treatment to about six months, though its use may vary by local guidelines and susceptibility data. Dosing is adjusted for pregnancy to account for physiological changes that affect drug levels, ensuring the regimen remains both safe and effective.