Special Populations

Patients with CNS TB usually are treated for longer periods (9-12 months instead of 6

2,12,34

months) because the consequences of undertreatment are severe. ' ' TB of the bone

2,12,34

typically is treated for 6 to 9 months, occasionally with surgical debridement. ' '

Drug selection is the same as for pulmonary disease. Extrapulmonary TB of the

2,12,34

soft tissues can be treated with conventional regimens. ' ' TB in children may be treated with regimens similar to those used in adults, although some physicians extend

treatment to 9 months. ''''' ' Pediatric doses of isoniazid and rifampin on a milligram per kilogram basis are higher than those used in adults34 ( ).

Pregnant women receive the usual treatment of isoniazid, rifampin, and ethambutol for 9 months.2,34,38,41,43 Pyrazinamide has not been studied in large numbers of pregnant women, but anecdotal data suggest that it may be safe.34 B vitamins should be provided. Streptomycin, other aminoglycosides, capreomycin, and ethionamide generally are avoided because they have been associated with toxic effects on the fetus.34,44 Para-aminosalicylic acid and cycloserine are used sparingly.44 Quinolones generally are avoided in pregnancy because of concern about adverse effects on cartilage development.34,44 Although most antituberculosis drugs are excreted in breast milk, the amount of drug received by the infant through nursing is insufficient to cause toxicity. Quinolones should be avoided in nursing mothers, if possible, for the same reason as above.

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