Literature review for - Flourish Paediatrics

Tuberculosis and Breastfeeding
Search results
The initial search of the databases included 92 references on tuberculosis (TB) and
breastfeeding. The detailed search is included in a separate document on searches. Data
were extracted from 9 references (8 narrative reviews, 1 case-series-post test) and the
information from 8 of those publications has been summarised below.
Notes on tuberculosis and breastfeeding
Breastmilk does not contain tubercle bacilli, so women with inactive TB may breastfeed
(Pronczuk, Akre et al. 2002; Lawrence and Lawrence 2004; Aquilina and Winkelman 2008;
Nhan-Chang and Jones 2010).
Women with untreated, active TB should be separated from the infant to prevent respiratory
transmission regardless of mode of infant feeding. A mother may resume breastfeeding once
adequate therapy has begun and the mother has a negative sputum culture (Lawrence and
Lawrence 2004; Aquilina and Winkelman 2008; Nhan-Chang and Jones 2010).
Once treatment has occurred and the mother has a negative sputum culture expressed
breastmilk can be given safely to the infant, the only contraindication being when the mothers
has an active breast lesion or TB mastitis. In this case, breastmilk cannot be fed to the infant
until the lesion is healed or the mastitis is eliminated (Lawrence and Lawrence 2004;
Aquilina and Winkelman 2008).
The WHO recommend that infants at risk of TB infection receive 6 months of isoniazid
preventive therapy (IPT) which includes 5 mg/kg of isoniazid daily, followed by BCG
vaccination. Follow-up should be at least every 2 months until treatment is complete.
Breastfeeding can be safely continued in children during follow-up. An alternative policy is
to give 3 months of IPT, then perform a TST. If the test is negative, daily isoniazid should be
stopped and BCG vaccination given. If the test is positive, daily isoniazid should be
continued for another 3 months, after which it should be stopped and BCG given (WHO
2007).
First line antituberculin drugs are thought to be compatible with breastfeeding by paediatric
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