Pyridoxine, 10 mg/day (other guidelines recommended 25 mg/day68), should always be given with isoniazid during pregnancy because of

increased requirement of this vitamin in pregnant women and to prevent potential neurotoxicity in the fetus.69,72,76 The women should be monitored IDH inhibitor cancer for compliance to and toxicity of the drugs. Hepatotoxicity of isoniazid remains a major concern especially during the peripartum period.68 Short-course chemotherapy for 6 months (2HRZE, 4HR given daily) is effective in pregnancy. An intermittent regimen (three times a week, on alternate days) under the directly observed treatment – short-course (DOTS) strategy of the Revised National Tuberculosis Programme is also used for pregnant women.25,69 Multidrug-resistant TB (resistant to both isoniazid and rifampicin) requires second-line selleckchem anti-TB drugs, which may not be safe during pregnancy because of teratogenic effects (especially aminoglycosides and quinolones).5 In this situation, detailed counseling is necessary regarding potential maternal-fetal hazards and scope for therapeutic abortion. Although overall evidence is scanty and contradictory, a recent report

suggested favorable perinatal outcome in a group of 38 women with multidrug-resistant TB.24 Treatment must be initiated and closely monitored by an expert in TB management. All first-line anti-TB drugs cross into breast milk in variable amounts.71,77,78 The drug level in milk is less than 1% of the maternal dose except for isoniazid, where it ranges between 0.75% and 2.3%.71,78 Although streptomycin is excreted into breast milk, no significant effect on the infant is seen, as it is very Rebamipide poorly absorbed from the gut.71 The risk of toxic reactions to anti-TB drugs in breast-fed infants is low, and it can be further minimized if the mother takes her medication just after breast-feeding.5 All the first-line drugs are considered to be compatible with breast-feeding by several national and international organizations.69,74,79 Despite the safety of breast-feeding, there is a common tendency to avoid breast-feeding because of ignorance.34 The WHO reinforces that the women with TB should breast-feed

normally while taking anti-TB drugs, and the mother and baby should stay together.69 TB in the neonate can be either congenital (i.e., acquired in utero) or neonatal (i.e., acquired early in life from the mother or other persons). Sources of fetal infection can be hematogenous spread from placenta, or aspiration/ingestion of infected amniotic fluid. Hematogenous spread leads to formation of a primary complex in the liver or a caseating hepatic granuloma, whereas aspiration or ingestion of infected amniotic fluid results in primary complex in lungs or gastrointestinal tract, respectively.5,15,80 Sometimes, ingested tubercle bacilli enter the Eustachian tubes, leading to TB of the middle ear. Endometrial TB can be an important cause of congenital TB in India and other low-resource countries.