RESUMEN

El tratamiento de la tuberculosis resistente a la rifampicina y multirresistente en mujeres embarazadas es complicado ya que se sabe poco sobre la seguridad de los fármacos antituberculosis de segunda línea durante el embarazo y la lactancia. La tuberculosis farmacorresistente, no tenía muchas opciones en el pasado, se ha tratado con regímenes que incluyen medicamentos con potencial teratogénico, como tioamidas e inyectables de segunda línea. Actualmente, hay nuevos medicamentos orales, incluida la bedaquilina, para el tratamiento de enfermedades resistentes a los medicamentos de primera línea; sin embargo, la seguridad de la bedaquilina durante el embarazo y la lactancia no se ha demostrado satisfactoriamente hasta el momento. Reportamos el primer caso en México tratado con un régimen que incluye bedaquilina para la tuberculosis multirresistente durante el embarazo, con resultados favorables, y sin complicaciones materno-fetales.

PALABRAS CLAVE

tuberculosis, resistencia a la rifampicina, multidrogo-resistencia, embarazo, bedaquilina.

REFERENCIAS

1. World Health Organization. Tuberculosis country profiles [Internet]. Tuberculosis country profiles. [Cited 2022 Jan 31]. Available in: https://www.who.int/teams/global-tuberculosis-programme/data

2. Tuberculosis en las Américas. Informe regional 2020 [Internet]. Pan American Health Organization; 2021 [Cited 2022 Jan 30]. Available in: https://iris.paho.org/handle/10665.2/55047

3. Mathad JS, Gupta A. Tuberculosis in Pregnant and Postpartum Women: Epidemiology, Management, and Research Gaps. Clin Infect Dis. 2012;55(11):1532-1549. Available in: https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cis732

4. Figueroa-Damián R, Arredondo-Garc??a JL. Neonatal Outcome of Children Born to Women with Tuberculosis. Arch Med Res [Internet]. 2001;32(1):66-69. Available in: https://linkinghub.elsevier.com/retrieve/pii/S0188440900002666

5. Gupta A, Hughes MD, Garcia-Prats AJ, McIntire K, Hesseling AC. Inclusion of key populations in clinical trials of new antituberculosis treatments: current barriers and recommendations for pregnant and lactating women, children, and HIV-infected persons. PLOS Med. 2019;16(8):e1002882. Available in: https://dx.plos.org/10.1371/journal.pmed.1002882

6. Palacios E, Dallman R, Muñoz M, Hurtado R, Chalco K, Guerra D, et al. Drug?resistant tuberculosis and pregnancy: treatment outcomes of 38 cases in Lima, Peru. Clin Infect Dis. 2009;48(10):1413-1419. Available from: https://academic.oup.com/cid/article-lookup/doi/10.1086/598191

7. World Health Organization. WHO consolidated guidelines on drug-resistant tuberculosis treatment [Internet]. Geneva: World Health Organization; 2021 [cited 2022 Jan 30]. Available in: https://apps.who.int/iris/handle/10665/350476

8. Loveday M, Hughes J, Sunkari B, Master I, Hlangu S, Reddy T, et al. Maternal and infant outcomes among pregnant women treated for multidrug/rifampicin-resistant tuberculosis in South Africa. Clin Infect Dis. 2021;72(7):1158-1168. Available in: https://academic.oup.com/cid/article/72/7/1158/5788430

9. Marais BJ. Good outcomes in babies with in utero bedaquiline exposure. Clin Infect Dis [Internet]. 2021;72(7):1169-1170. Available in: https://academic.oup.com/cid/article/72/7/1169/5771517

10. Acquah R, Mohr-Holland E, Daniels J, Furin J, Loveday M, Mudaly V, et al. Outcomes of children born to pregnant women with drug-resistant tuberculosis treated with novel drugs in Khayelitsha, South Africa: a report of five patients. Pediatr Infect Dis J. 2021;40(5):e191-e192. Available in: https://journals.lww.com/10.1097/INF.0000000000003069