Tran J H, Montakantikul P
University of Illinois at Chicago Medical Center, USA.
J Hum Lact. 1998 Dec;14(4):337-40. doi: 10.1177/089033449801400427.
Most antituberculosis drugs appear to be safe for use with breastfeeding. These agents are excreted in breast milk at relatively small concentrations. No adverse effects have been reported to date. The percentages of the therapeutic dose of antituberculosis agents that potentially may be delivered to the nursing infants range from 0.05% to 28%. Currently isoniazid, rifampin, ethambutol, streptomycin (first-line agents), kanamycin and cycloserine (second-line agents) are the only agents considered by the AAP to be compatible with breastfeeding. Unfortunately, there are still no clear data on the safety of pyrazinamide, ethionamide, and capreomycin during breastfeeding. If the mother chooses to breastfeed, it may be prudent to examine the infant for signs and symptoms of toxicity. In infants requiring treatment with antituberculosis agents, it is important to use therapeutic doses since drug concentrations in breast milk are not adequate as effective therapy for treatment or prevention. However, dosing at the lower end of the therapeutic range should be prescribed (i.e., 10 mg/kg/day of isoniazid) to decrease the risk of toxicity.
大多数抗结核药物在母乳喂养期间使用似乎是安全的。这些药物在母乳中的排泄浓度相对较低。迄今为止，尚未报告有不良反应。可能传递给哺乳婴儿的抗结核药物治疗剂量的百分比范围为0.05%至28%。目前，异烟肼、利福平、乙胺丁醇、链霉素（一线药物）、卡那霉素和环丝氨酸（二线药物）是美国儿科学会认为与母乳喂养相容的仅有的药物。不幸的是，关于吡嗪酰胺、乙硫异烟胺和卷曲霉素在母乳喂养期间的安全性仍没有明确数据。如果母亲选择母乳喂养，检查婴儿是否有毒性体征和症状可能是谨慎的做法。对于需要用抗结核药物治疗的婴儿，使用治疗剂量很重要，因为母乳中的药物浓度不足以作为治疗或预防的有效疗法。然而，应开出处方使用治疗范围下限的剂量（即异烟肼10mg/kg/天）以降低毒性风险。
