Snider D E, Layde P M, Johnson M W, Lyle M A
Am Rev Respir Dis. 1980 Jul;122(1):65-79. doi: 10.1164/arrd.1980.122.1.65.
The pregnant woman with tuberculosis who requires treatment presents a therapeutic dilemma; therefore, we reviewed all available literature on pregnant women treated with isoniazid (INH), ethambutol (EMB), rifampin (RMP), or streptomycin (SM) and report here on the relative safety of these drugs and whether the risk of teratogenesis justifies abortion on medical grounds. Other than the ototoxicity of SM, none of these drugs in normal dosages are proved teratogens to human fetuses. We recommend the use of INH in combination with EMB for a pregnant woman with tuberculosis, if the disease is not extensive. If a third drug is warranted, then RMP could be added. Because of its ototoxicity, SM should not be used, unless RMP is contraindicated or proves unsatisfactory. Routine therapeutic abortion is not medically indicated for a pregnant woman who is taking first-line antituberculosis drugs.
需要治疗的患结核病孕妇面临着治疗上的两难困境；因此，我们查阅了所有关于用异烟肼（INH）、乙胺丁醇（EMB）、利福平（RMP）或链霉素（SM）治疗孕妇的现有文献，并在此报告这些药物的相对安全性，以及致畸风险是否足以成为基于医学理由进行堕胎的依据。除了链霉素的耳毒性外，这些药物在正常剂量下均未被证实对人类胎儿有致畸作用。对于病情不严重的患结核病孕妇，我们建议使用异烟肼联合乙胺丁醇。如果需要使用第三种药物，可以加用利福平。由于链霉素具有耳毒性，除非利福平禁忌或效果不佳，否则不应使用。对于正在服用一线抗结核药物的孕妇，常规治疗性堕胎并无医学指征。
