Improving Patient Adherence to Tuberculosis Treatment
Adherence by Children and Adolescents
Children with TB present specific problems for adherence. However,
there is very little information about the rates of adherence among
children or methods for improving it. Many children with TB have
few or no symptoms of the disease, and many do not experience a
dramatic improvement in symptoms when given appropriate treatment.
Because of the characteristics of the disease in children, you may
have difficulty convincing parents that their children are ill and
need treatment and that the treatment needs to be given as prescribed
To improve adherence among children, work with the parents or caregivers
who will administer medications to young children. You cannot assume
that parents will give medications to their children as prescribed;
some parents are nonadherent (it is difficult to get children to
take medicines that taste unpleasant). Every measure to ensure adherence
in patients must also be taken to ensure that parents give needed
TB medications to their children. Consider additional measures to
accommodate the special needs of young children.
Provide anticipatory guidance. Talk with parents about the
potential problems they may experience with their children when
TB treatment is initiated. Children may
- resist taking medications
- have difficulty swallowing pills and capsules, the common
form of TB medications
- experience adverse reactions to the medications
When parents are aware of the potential problems that can arise
during their child's treatment, they are better able to cope
with the problems and assist with the treatment.
- Give DOT. Consider giving DOT to children with TB when you are
unable to ensure that their parents or caregivers are administering
the medications as prescribed. Supplement DOT with incentives
and enablers (such as coloring books and toys) to encourage cooperation
from the child.
- Give TB medications in easy-to-take preparations. Rifampin (RIF)
can be made into a liquid suspension by the pharmacist. Isoniazid
(INH) can also be prepared as a suspension, although its stability
varies. INH and pyrazinamide (PZA) pills can be crushed and given
with small amounts of food; RIF should be taken on an empty stomach
Adolescents may be responsible for taking their own medications,
but they are also at high risk for poor adherence. Because of their
concerns about the opinions of peers, adolescents may be particularly
embarrassed about having to take TB medications. Also, they may
not feel threatened by TB and may not take the condition seriously.
For these reasons, adolescents are a high priority group for DOT.
Children and adolescents need carefully individualized treatment
plans. Be vigilant in monitoring adherence and creative in finding
ways to ensure adherence.