8.7 Preventive therapy for children

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Children are more susceptible to TB infection, more likely to develop active TB disease soon after infection and are more likely to develop severe forms of disseminated TB. Children aged less than 5 years of age, who are close contacts of a bacteriologically confirmed (smear or Xpert +ve) TB patient, should be evaluated for active TB by a medical officer / paediatrician. After excluding active TB, the child should be given INH preventive therapy irrespective of their BCG or nutritional status. The dose of INH for preventive therapy is 10 mg/kg body weight, administered daily, for a period of six months.

The child should be followed up at least once a month till the completion of chemoprophylaxis. An infant born to a mother with infectious pulmonary TB can be safely breastfed if isoniazid prophylaxis is given. If a child receiving isoniazid develops symptoms, he or she should be assessed for TB. If the child has not been vaccinated with BCG, it should be given after completion of isoniazid prophylaxis.

Serious limitations of the quality of evidence prevent drawing any recommendations on MDR-TB preventive therapy as a public health measure. Strict clinical observation and close monitoring for the development of active TB disease for at least two years is preferred over the provision of preventive treatment for contacts with MDR-TB cases.