Multi-drug Resistant Tuberculosis in Pregnancy: Need for More Intensive Treatment

Abstract

An approved treatment regimen for multi-drug resistant tuberculosis (MDR-TB) patients during pregnancy does not exist to this day. The main reason for the lack of information in this area is the small number of patients and insufficient studies regarding the safety of the second-line drugs during pregnancy on the mother and the fetus [1]. This case report highlights the difficulties associated with MDR-TB. In December 2003, an 18-year-old Afghan woman was admitted to our center on complaints of cough, sputum, and dyspnea. The patient had a history of two periods of anti-TB treatments (Cat I and Cat II) in the past two years. Despite two years of anti-TB treatment the patient’s mother died secondary to TB. The patient’s chest X-ray demonstrated opacity accompanied by a cavity in the middle-upper lobe of the right lung, and alveolar infiltration together with nodular densities in the lower lobe of the left lung. Sputum smear was positive for Koch’s Bacillus (BK). An empirical regimen for MDR-TB was commenced because of a positive smear of sputum for BK (Ofloxacin, high-dose Isoniazid, Amikacin, Clofazimin, Pyrazinamid, and B6). After completion of five months of therapy, sputum smear and culture results were negative again. The performed chest X-ray at this stage demonstrated a decrease in the size of the right cavitary lesion. Considering the results of the patient’s drug susceptibility test, which demonstrated resistance to the four drugs Isoniazid, Rifampin, Ethambutol, and Streptomycin, and sensitivity to Pyrazinamid, the treatment regimen was continued. Earlier in the treatment the patient was advised to refrain from becoming pregnant and educated regarding the potential teratogenic side effects of anti-TB medications on the fetus and the need for up to 18 months