A primigravida in first trimester was observed to be sputum positive for acid fast bacilli. She had no previous history of tuberculosis. Which of the following should be the treatment strategy?: (A) Category I DOTS, (B) Category II DOTS, (C) Category III DOTS, (D) Defer treatment
Answer is A. The patient in the clinical scenario is a sputum positive newly diagnosed case thus belongs to the category I. Patients in this category are given Rifampicin / Ethambutol / Isoniazid / Pyrazinamide for 2 months followed by Rifampicin/Isoniazid thrice weekly for 4 months. All the above mentioned drugs can be safely used in pregnancy. While streptomycin, ethionamide and fluroquinolones are teratogenic. Ref: Emerging Infections in Asia By Yichen Lu, Max Essex, Bryan Robes, Pages 217-219; Park textbook of preventive and social medicine 21st edition Page 173.