special situations

Last reviewed 01/2018

Consult specialist advice.

The common special situations are:

  • renal failure:
    • rifampicin, isoniazid and pyrazinamide may be used in standard doses
    • streptomycin and ethambutol should be used with caution and require close monitoring of drug levels

  • pregnancy (1):
    • streptomycin (hearing loss of the child due to permanent damage of the eighth nerve); also ethionamid should be avoided
    • drugs that can be used in pregnancy, generally in combination, are ethambutol, isoniazid and rifampicin
    • ethambutol is the first-line treatment
      • easy for the patient to take and reasonably safe in pregnancy
    • if woman is receiving isoniazid the she should also take pyridoxine (50mg per day) - this is because isoniazid is known to cause peripheral neuritis and there is an increased requirement for this vitamin in pregnancy
      • isoniazid treatment may cause hepatitis - thus patients should have monthly liver function tests
    • breast feeding is relatively safe with both ethambutol, isoniazid and and rifampicin
    • rifampicin and isoniazid may be used in standard doses
    • pyrazinamide, can be used in pregnancy beyond the first trimester provided that the benefits outweigh potential risks
    • tuberculosis therapy should continue for six to nine months depending on the chemotherapeutic regimen followed
    • the neonate should receive prophylactic isoniazid for three months and, in the UK, a BCG vaccination is given after this period

  • liver disease:
    • rifampicim, isoniazid, pyrazinamide and ethambutol may be use in standard doses
    • liver function tests should be performed regularly

  • tuberculous meningitis:
    • rifampicin, isoniazid, pyrazinamide and ethionamide enter the CSF most effectively
    • intrathecal administration is not required


  1. Prescriber (2005); 16 (8).