Tuberculosis in Children

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Therapy for Tuberculosis

Commonly used antituberculous drugs

The table-1 clearly illustrates the drugs, their dosages and adverse effects.

Treatment recommendations for the various forms of tuberculosis

Group-I (Prevention therapy) - 6 months of Isoniazid and Rifampicin.

The consensus statement of the IAP working group is Monotherapy has no

place except in BCG adenitis (6H).

1. Group 1 (Prevention therapy) _ 6HR

a) Asymptomatic Mantoux positive < 3 years

b) Asymptomatic Mantoux positive < 5 years with Grades III, IV PEM

Asymptomatic Mantoux +ve implies that the

patient has no tuberculous lesion and only a tuberculin positivity.

c) Recent converter to Mantoux +ve without signs (Healed lesion: Normal CXR/Calcification/Fibrosis)

d) Children < 3 years of age with history of contact

e) Children < 5 years of age with history of contact with PRIM III & IV

2. Group 2 _ 2 HRZ/4HR

a) Primary complex (Lungs)

b) Symptomatic mantoux +ve < 3 years without localization

c) Symptomatic mantoux +ve < 5 years without localization

with PEM Gr III, IV

d) Isolated lymphadenitis

e) Pleural effusion

3. Group 3 _ 2HRZE/4 HR(extend HR to 7 months if there is no improvement)

a) Progressive pulmonary disease

b) Multiple tuberculous lymphadenitis.

4. Group 4 _ 2HRZE/7HR

a) Miliary / Disseminated TB

b) Bronchopneumonia / cavity

c) Abdominal, pericardial, genitourinary disease, osteoarticular

5.Group 5 _ 2HRZE / 10 HRE

Neurotuberculosis

Special situations:

I. Baby born to mother with tuberculosis (Diagnosed in 3rd Trimester)

  • To continue breast feeding
  • BCG must be given
  • If chest x-ray is normal, to give 6 HR
  • If chest x-ray is abnormal, to give 2HRZ/
  • 4HR.

II. Congenital tuberculosis - 2HRZ/7HR

Table-1

Sl. No. Name of drug Daily dosage Main adverse effects (mg/kg/d)

01 Isoniazid (H)+ 5 Hepato toxicity

02 Rifampicin 10 Hepato toxicity

03 Pyrazinamide (Z) 30 Hepato toxicity

04 Ethambutol (E) 15 Visual disturbance

05 Streptomycin (S) 15 Ototoxicity, Nephro

Toxicity

1. + Newer < 5mg/kg; to be rounded off to the closest higher value

2. All drugs should be administered in a single daily dose on empty stomach

3. Drug is safe, if used in recommended dosage schedule.

4. Vit B6 is not necessary in children on INH.

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KrishnanS 

Very simple, informative and good coverage of the topic.
Dr S krishnan
Apollo-Hyderabad

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