8.6 Treatment of TB in children

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Once a diagnosis of TB has been made, most children may be treated on an outpatient basis; however, children with severe disease will require hospitalization. Children with any of the following conditions must be admitted to the hospital:

  • respiratory distress
  • severe forms of EPTB such as TB meningitis, miliary TB, spinal TB and pericardial TB
  • severe adverse reactions such as hepatotoxicity

All children with TB will receive a standard treatment regimen. All seriously ill children who have been previously treated for TB, such as, relapse, treatment after failure, treatment after lost to follow up or not improving on new treatment regimen should be investigated for drug resistant TB. Ensure strict DOT in all cases of TB in children.

8.6.1 Recommended treatment regimen

Anti-TB treatment is divided into two phases: an intensive phase and a continuation phase. The purpose of the intensive phase is to rapidly eliminate the majority of organisms and to prevent the emergence of drug resistance. The purpose of the continuation phase is to eradicate the dormant organisms.

TB drugs for the treatment of TB in children come in Fixed Dose Combinations (FDC) and dosed according to standardized weight bands. Depending on their weight, children can be treated using the pediatric FDCs or the adult FDCs. Older children falling into higher weight ranges will receive adult FDCs.

All children must be treated using child-friendly (dispersible and flavoured) FDC. The new fixed-dose combination of HRZ (50 mg / 75 mg / 150 mg) and HR (50 mg / 75 mg).

Ethambutol is included for the treatment of TB in children and comes as a separate tablet (to monitor ophthalmic ADRs) with the paediatric formulation (100 mg).

Weight band for INH mono resistant TB (Hr-TB)

If levofloxacin 100mg dispersible tablet is not available, the 250mg tablet can be used with 6(H) RZ+E in children aged 0-14 years, based on a slightly different weight band from the one above:

8.6.2 Treatment duration

Pulmonary TB and EP TB are treated for 6 months (2 months of HRZE + 4 months HR). All severe forms of EP TB are treated for 9-12 months by extending the CP by 3-6 months. These include TB meningitis, TB osteomyelitis, military TB, TB pericarditis/effusion and other severe forms of TB (2 months HRZE + 7-10 months HR - a total treatment duration of 9 to 12 months).

Pyridoxine

Pyridoxine should be given along with isoniazid in HIV infected children to prevent isoniazid associated neuropathy. A dose of 12.5 mg/day is recommended for children 5 to 11 years of age, and 25 mg/day for children ≥12 years.

Corticosteroid

Corticosteroids should generally be used sparingly in children, but are of benefit in cases of TB meningitis, some cases of TB pericarditis and in managing complications of airway obstruction caused by TB lymphadenitis.

In such cases, prednisolone should be given at a dose of 2mg/kg/day for 4 weeks. The dose should then be gradually reduced over 1-2 weeks before stopping. The dosage can be increased to 4mg/kg/day (maximum: 60mg/day) in the case of seriously ill children to account for increased steroid metabolism induced by rifampicin.