Tuberculosis in pregnancy and childbirth.
Today in tuberculosis therapy in pregnancy and childbirth are using some medicines with fixed doses such as:
- derivatives of semi-synthetic antibiotic rifampicin – rifapentine and rifabutin;
- derivatives of isoniazid – flurenizide, ftivazid;
- latest fluoroquinolone – lomefloxacin, moxifloxacin, gatifloxacin;
- some macrolides (clarithromycin, azithromycin), amoxiclav, tioatsetazon;
- and a number of antituberculosis medicines combined .
In the appointment of chemotherapy – TB patients must adhere to certain principles. Assigning combinations of several anti-tuberculosis medicines increases the efficiency and prevents the development of drug resistance of MBT.
There is two steps of antimycobacterial treatment. The initial phase is intensive. Its purpose – to stop reproduction of microorganisms and the elimination of acute manifestations of the disease. Also medications should stop allocation of bacteria and to achieve significant results in resorption of infiltrative changes, in some patients – the healing of decay cavities. In this phase is used the five chemotherapy medicines daily for about three months. The second phase – is supportive medical therapy, the purpose of which is to achieve a sustained clinical benefit. In this stage is most often used 2-3 medicines daily or intermittently.
Doctors use one dose of chemotherapy medicines at one day – to achieve their maximum concentration in the blood and tissues and because of slow reproduction bacteria (once in 20-24 hours).
The duration of the basic course – at least, of six months (6 to 18 months), due to the slow pace of reparative processes and mainly because of bacteriostatic effect of therapeutic doses of anti-tuberculosis medicines.
Doctors should check the sensitivity of tuberculous bacteria to anti-tuberculosis medicines, because increased the number of drug-resistant strains of microorganisms.
It is also necessary to monitor the intake of anti-TB drugs in patients. Because the clinical manifestations of tuberculosis are often quickly pass (so patients stop taking medication daily), and sustainable healing process occurs much later.
Treatment at stage one spend with 5-6 individualized medicines 1 and 2 series based on ILO resistance. Duration of treatment – 12-24 months.
Most chemotherapy regimens are highly effective, they can be applied to women in the postpartum period, when there are no contraindications for any anti-TB drugs (except fluoroquinolone in lactation period).