Treatment of tuberculosis infection (latent tuberculosis) in pregnancy*^¶

TST: tuberculin skin test; IGRA: interferon-gamma release assay; TBI: tuberculosis infection.

* The regimens summarized in the table are for treatment of TBI due to Mycobacterium tuberculosis presumed to be susceptible to isoniazid and rifamycins. For details regarding treatment of drug-resistant TBI, refer to the UpToDate topic on treatment of TBI.

¶ Tuberculosis terminology is inconsistent in the literature. Tuberculosis infection is a newer term for latent tuberculosis infection (older term); these terms refer to the clinical state in which there is evidence of cell-mediated immunologic response following exposure to Mycobacterium tuberculosis-derived protein antigens in solution (eg, positive TST and/or IGRA), in the absence of signs or symptoms of illness. Terms referring to presence of signs or symptoms reflecting illness due to M. tuberculosis include tuberculosis disease (newer term) or active tuberculosis (older term).

Δ Safety data for rifapentine in pregnancy are limited; therefore, neither the three-month weekly isoniazid and rifapentine (3HP) regimen nor the one-month daily isoniazid and rifapentine (1HP) regimen are recommended for individuals who are pregnant or expecting to become pregnant during the treatment period.

◊ Peripheral neuropathy can occur among patients on TBI regimens containing isoniazid due to interference with metabolism of pyridoxine and can be prevented with pyridoxine (vitamin B6) supplementation (25 to 50 mg daily). This is especially important for patients with pregnancy as well as seizure disorders and conditions that can predispose to neuropathy (including diabetes, uremia, alcoholism, malnutrition, and HIV infection). Breastfed infants whose mothers are taking isoniazid do not require pyridoxine supplementation (unless the infant is also receiving isoniazid themselves).