Treatment of choice for sputum positive pulmonary tuberculosis detected in 1st trimester of pregnancy:
Correct Answer: Start cat. I immediately
Description: Ans is 'b' i.e. Start cat. I immediately Repeat May 09Sputum positive pulmonary tuberculosis falls under category I.Active tuberculosis in pregnancy must be treated. "Untreated tuberculosis represents a far greater hazard to a pregnant woman and her fetus than does treatment of the disease. CDC (2003, 62).Treatment of active tuberculosis disease should be initiated as soon as the diagnosis is made.So Cat. I ATT should be started promptly as maternal tuberculosis is associated with:increased risk of spontaneous abortionperinatal mortalitysmall for gestation agelow birth weightFirst line drugs can be safely used in pregnancy except streptomycin which is contraindicated because of its associated with fetal ototoxicity.Second line drugs are not recommended in pregnancy (They are used only if benefit outweighs the risk, as in case of MDR tuberculosis)Pyrazinamide is not recommended by CDC (USA) in absence of sufficient safety data, however many tubercular authorities all over world support its use. CDC recommends an alternative 9 month regimen containing isoniazid and rifampin throughout (supplemented by ethambutol, until drug susceptibility results are available).Breastfeeding is not contraindicated in women using antituberculosis drugs.
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