One or two hepatotoxic drugs may be used in moderately severe disease (e.g., Childs B cirrhosis) whereas hepatotoxic drugs are completely avoided in decompensated Child C cirrhosis. •  Two hepatotoxic drugs
–  9 months of Isoniazid, Rifampin and Ethambutol (until or unless isoniazid susceptibility is
documented)
–  2 months of Isoniazid, Rifampin, Ethambutol and Streptomycin followed by 6 months of Isoniazid and Rifampin
•  One hepatotoxic drug
–  2 months of Isoniazid, Ethambutol & Streptomycin followed by 10 months of Isoniazid and Ethambutol
• No hepatotoxic drugs
– 18–24 months of Streptomycin, Ethambutol and Quinolones
Patients with liver disease should have their liver function tests monitored regularly throughout TB treatment. Drug-induced hepatitis is discussed in a separate section above. Pregnancy
Pregnancy itself is not a risk factor for TB. Rifampicin makes hormonal contraception less effective, so additional precautions need to be taken for birth control while tuberculosis treatment. Untreated TB in pregnancy is associated with an increased risk of miscarriage and major fetal abnormality, and treatment of pregnant women. The US guidelines recommend omitting PZA when treating TB in pregnancy; the UK and WHO guidelines make no such recommendation, and PZA is commonly used in pregnancy. There is extensive experience with the treatment of pregnant women with TB and no toxic effect of PZA in pregnancy has ever been found. High doses of RMP (much higher than used in humans) causes neural tube defects in animals, but no such effect has ever been found in humans. There may be an increased risk of hepatitis in pregnancy and during the puerperium.
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