Interventions for Tuberculosis Control and Elimination 2002

and no association with diarrhea. 584 Similarly, studies in South Africa have
shown that malabsorption in asymptomatic HIV-infected patients is not a
major issue and no important pharmacokinetic differences have been seen
in a series of AIDS patients. 585 Thus, malabsorption of anti-tuberculosis
medications in HIV-infected patients may not be that serious a problem.
Nevertheless, it is probably reasonable to always include the parenteral
streptomycin in patients suspected of having malabsorption.
The pregnant patient
Pregnant women with tuberculosis do not pose particular problems for treatment.
Dose adjustment is probably indicated with increasing body weight
as the volume of distribution increases. Because of the potential of
vestibulo-cochlear toxicity to the fetus, streptomycin should not be given
in pregnancy. Isoniazid, rifampicin, ethambutol, pyrazinamide, and thioacetazone
are safe in pregnancy, and are not reported to have teratogenic or
other adverse effects on the fetus.
Second-line drugs that should be avoided in pregnancy include other
aminoglycosides, polypeptides, thioamides, and quinolones.
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