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U.S. Department of Health and Human Services

  

Core Curriculum on Tuberculosis, 2000

Chapter 7
Treatment of TB Disease

Regimens

Children and Adolescents

Infants and children with TB should be treated with one of the regimens mentioned in the section Treatment of Pulmonary TB. In infants, TB is much more likely to disseminate; therefore, prompt and vigorous treatment should be started as soon as the diagnosis is suspected. The specific intermittent regimens have not been studied in children. Ethambutol is generally not used for young children whose visual acuity cannot be monitored. If ethambutol must be used to treat a young child (e.g., because of drug-resistant TB), the minimum dose of this drug should be used. 17

Sputum specimens collected from children are often inadequate. In these situations, it may be necessary to rely on the results of cultures and susceptibility tests of specimens from the adult source case to confirm the diagnosis in the child and to guide the choice of drugs. When drug-resistant TB is suspected or isolates from a source case are not available, it may be necessary to perform gastric aspiration or bronchoalveolar lavage, or obtain tissue samples for diagnosis.

For children, bacteriologic examinations are also less useful for evaluating the response to treatment than for adults; thus, clinical and radiographic examinations are more important for children. Furthermore, the chest radiographs of children with hilar adenopathy may not become normal for 2 to 3 years after treatment. It is not necessary for the chest radiograph to be normal before discontinuing TB drugs once a full course of therapy is completed.

In general, extrapulmonary TB in children can be treated with the same regimens as pulmonary TB. The exceptions are bone and joint disease, disseminated (miliary) disease, and meningitis, for which a minimum for 12 months of therapy is recommended.

TB Treatment for HIV-Positive Children
In HIV-positive children, even in those who are too young to be evaluated for visual acuity and red-green perception, ethambutol at a dosage of 15 mg/kg body weight should generally be included as part of the initial regimen, unless the infecting source patient is known to have TB susceptible to isoniazid and rifampin. If drug susceptibility results are not available, a four-drug rifamycin-based regimen (e.g., isoniazid, rifamycin, pyrazinamide, and ethambutol) for 2 months, followed by isoniazid and a rifamycin for 4 months, is recommended.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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