DR-TB Treatment in Pregnancy: Recommendation for the Use of Contraception​

All women of childbearing age who are awaiting results of the Culture and Drug Susceptibility Test (C&DST), as well as those receiving Drug-resistant TB (DR-TB) treatment, should be advised and counselled intensively to use birth control measures because of the potential risk to both the mother and the foetus.​

• It should be noted that oral contraceptives might have decreased efficacy due to vomiting and drug interactions with DR-TB drugs (use of Rifampicin in mono/poly resistant TB).​
• Contraception methods that can be used during DR-TB treatment, based on individual preference and eligibility are: ​
  • Barrier methods (e.g., condoms/ diaphragms)​, intrauterine devices (e.g., CuT), Depot medroxyprogesterone (Depo-provera)​.
• In women, the Isoniazid (H) mono/poly DR-TB regimen may be started or continued safely, except that care should be taken while using oral contraceptives. ​
• A woman on oral contraception, while receiving rifampicin treatment may choose between two options following consultation with a physician: ​
  • Use of an oral contraceptive pill containing a higher dose of oestrogen (50 μg)​
  • Use of another form of contraception. 

Resources​

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021. 
• Consolidated Guidelines on Tuberculosis: Module 4 - Treatment: Drug-resistant TB Treatment, 2020.  ​​
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.  ​
• Collaborative Framework for Management of Tuberculosis in Pregnant Women, 2021.  

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