Contraindicated Medication for Tuberculosis in Pregnancy
Streptomycin is absolutely contraindicated in pregnant women with tuberculosis due to its ototoxic effects on the fetus, which can cause congenital deafness. 1, 2
Why Streptomycin is Contraindicated
Aminoglycosides (streptomycin, kanamycin, amikacin) and capreomycin are contraindicated for all pregnant women because of potential adverse effects on the fetus, specifically ototoxicity that can result in permanent hearing loss and balance problems. 1
Streptomycin causes congenital deafness in approximately 17% of exposed fetuses, making it unacceptable for use during pregnancy regardless of the severity of maternal tuberculosis. 2
The FDA drug label explicitly states that streptomycin interferes with in utero development of the ear and may cause congenital deafness, and therefore should not be used in pregnant women. 3
Even in cases of drug-resistant tuberculosis where treatment options are limited, streptomycin remains contraindicated and alternative second-line agents must be selected. 1
Safe Medications for This Patient
The recommended initial treatment regimen for pregnant women with tuberculosis consists of isoniazid, rifampin, and ethambutol. 2, 4
Isoniazid (option d) is safe and recommended as a first-line agent in pregnancy, though pyridoxine (vitamin B6) supplementation at 25 mg/day should be given to prevent neurotoxicity. 2, 5
Rifampin (option e) is safe and should be included in all treatment regimens for pregnant women with tuberculosis. 1, 2
Pyrazinamide (option b) has historically not been routinely recommended in the United States due to inadequate teratogenicity data, but international organizations recommend its use, and for HIV-infected pregnant women, the benefits outweigh potential risks. 1 However, it is not contraindicated—just used with caution. 6
Cephalosporins (option a) are not anti-tuberculosis medications and are irrelevant to this clinical scenario. [@General Medicine Knowledge@]
Clinical Pitfalls to Avoid
Do not delay treatment in pregnancy—untreated tuberculosis poses a greater risk to both mother and fetus than the medications themselves. 2, 5
Do not confuse "not routinely recommended" (pyrazinamide in some guidelines) with "contraindicated" (streptomycin). Only streptomycin is absolutely contraindicated. 1, 2
Close monitoring of liver function is essential during treatment, as pregnancy may increase vulnerability to isoniazid hepatotoxicity, though pregnancy itself does not increase the risk of TB progression. 2, 5
Answer: c. Streptomycin