Question

A primigravida in the first trimester has sputum positive for acid fast bacillus. What is the preferred treatment?

• A. Treatment deferred till the second trimester
• B. Category 1 DOTS
• C. Category 2 DOTS
• D. Category 3 DOTS

Hint:

A new sputum-positive TB case gets the new-case first-line regimen, started immediately.

Answer 1

The Correct Option is B

Step 1: Establish the diagnosis. A sputum positive for acid fast bacillus in a symptomatic patient indicates active sputum-positive pulmonary tuberculosis. This is a new case in a previously untreated patient.
Step 2: Decide whether to treat in pregnancy. Active tuberculosis in pregnancy must be treated promptly. Untreated maternal TB is far more dangerous to both mother and fetus than the standard first-line drugs, so treatment is never deferred to a later trimester.
Step 3: Confirm drug safety. The first-line drugs isoniazid, rifampicin, ethambutol and pyrazinamide are considered safe in pregnancy. Streptomycin is the agent to avoid because it is ototoxic to the fetus.
Step 4: Select the correct DOTS category. Under the DOTS programme, a new sputum-positive pulmonary TB case is treated with the new-case regimen, which is Category 1 DOTS. Category 2 is reserved for previously treated cases (relapse, failure, default), and Category 3 was for less severe or smear-negative disease.
Conclusion: A new sputum-positive case in the first trimester is treated with Category 1 DOTS, so the answer is option B.