Maternal Tuberculosis (TBC)

Tuberculosis (TB) is an infection caused by the bacillus Mycobacterium tuberculosis.

Except in rare cases of mastitis TB, Mycobacterum tuberculosis is not transmitted through breast milk. ^{(Click 2018, Baquero 2015)}

WHO and most specialized medical societies recommend continued breastfeeding in all cases of maternal TB as long as the mother is treated and not contagious (sputum negative). There is no need for mother-infant separation except in the case of multidrug-resistant TB.

Translated with www.DeepL.com/Translator (free version)

The mother should wear a mask during the first days of treatment and the infant must be diagnosed and administered prophylaxis with isoniazid or TB treatment. ^{(Mittal 2014, WHO 2007 and 1998)}

According to Red Book 2021-24 and cited in Lawrence 2016 p427:

• Non-active maternal TB, without active lung lesions in the lung does not contraindicate breastfeeding or warrant separation.
• Active TB with pulmonary lesions requires separation and interruption of direct breastfeeding (but expressed breastmilk can be administered) up to 15 days after starting the treatment or analysis of negative sputum ^{(Di Comité 2016, Baquero 2015)}. (Although it is most likely that the infant will already have been exposed and what is required is diagnosis and prophylaxis with isoniazid or simultaneous treatment to that of the mother)
• Only in the rare case of tuberculous mastitis are both direct breastfeeding and the administration of expressed milk contraindicated. Except in cases of TB mastitis, Mycobacterum tuberculosis is not transmitted through breastmilk (Click 2018).

Breastfeeding is possible in mothers treated for multi-resistant TB. ^{(Drobac 2005).}

The amount of isoniazid that the infant receives through breastmilk is negligible ^{(Red Book 2021-24, Garessus 2019, Singh 2008)}. Drugs for the treatment of TB are compatible with breastfeeding ^{(Baquero 2015, Blumberg 2003, ATC 2003, WHO 2002, Tran 1998, Dautzenberg 1998, Snider 1994)} and transfer in such small amounts that there is no need to modify the dose of the treatment or prophylaxis of TB of the infant. ^{(Partosch 2018, Blumberg 2003, ATC 2003)}

The mother treated with isonicide should receive pyridoxine supplementation, but not the infant, unless the infant is also being treated with isoniazid. ^{(RedBook 2021-24)}

See below the information of these related products:

• Amikacin (Safe substance and/or breastfeeding is the best option.)
• BCG Vaccines for tuberculosis (Safe substance and/or breastfeeding is the best option.)
• Capreomycin Sulfate (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Ciprofloxacin (Safe substance and/or breastfeeding is the best option.)
• Clofazimine (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Cycloserine (Safe substance and/or breastfeeding is the best option.)
• Ethambutol Hydrochloride (Safe substance and/or breastfeeding is the best option.)
• Isoniazid (Safe substance and/or breastfeeding is the best option.)
• Kanamycin (Safe substance and/or breastfeeding is the best option.)
• Linezolid (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Para-aminosalicylic Acid (PAS) (Safe substance and/or breastfeeding is the best option.)
• Pyrazinamide (PZA) (Safe substance and/or breastfeeding is the best option.)
• Rifabutin (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Rifampicine (Safe substance and/or breastfeeding is the best option.)
• Streptomycin (Safe substance and/or breastfeeding is the best option.)
• Tuberculin (Safe substance and/or breastfeeding is the best option.)