Question:medium
A primigravida in the first trimester has sputum positive for acid fast bacillus. What is the preferred treatment?
A primigravida in the first trimester has sputum positive for acid fast bacillus. What is the preferred treatment?
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A new sputum-positive TB case gets the new-case first-line regimen, started immediately.
Updated On: Jun 24, 2026
- Treatment deferred till the second trimester
- Category 1 DOTS
- Category 2 DOTS
- Category 3 DOTS
Show Solution
The Correct Option is B
Solution and Explanation
Two decisions are bundled into this question: when to treat and which regimen to use. On timing, the rule in obstetrics is firm; active tuberculosis is a serious infection and the risk to the pregnancy from leaving it untreated greatly exceeds the risk from standard antitubercular drugs, so therapy is started without delay and is never postponed to a later trimester. On the regimen, this is a brand-new, previously untreated patient with a positive sputum smear, which places her in the new-case bracket of the national programme. The new-case bracket corresponds to the first-line short-course regimen, known as Category 1 under DOTS, built around isoniazid, rifampicin, ethambutol and pyrazinamide, all of which are acceptable in pregnancy. The categories meant for retreatment, namely the relapse and failure regimen, do not apply here because she has never been treated before, and the older category for milder disease is not appropriate for a smear-positive case. Hence the preferred course is to begin Category 1 DOTS at once. \[\boxed{\text{Category 1 DOTS}}\]
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