Active Disease in Children
Key Treatment Principles
- The treatment of TB in children should be undertaken in consultation with a physician experienced in its management, especially for patients with CNS, miliary, or multidrug-resistant (MDR) TB and with HIV infection.
- Treatment of tuberculosis benefits both the community as a whole and the individual patient; thus, all public health programs and private providers must not only prescribe an appropriate regimen but also ensure adherence until treatment completion.
- All new and suspected cases of TB should be reported to your state and local health departments so that source case or contact investigations can be conducted and case management provided.
- Children with active TB are often found to be smear and culture negative when clinical specimens (e.g., sputum, gastric aspirates, etc.) are examined; these children should be treated as having active disease not culture-negative TB. In such instances, when an isolate from a pediatric case is not available, drug susceptibility results from the adult source case can be used to guide therapy.
- All anti-TB medications should be given concurrently, as a single dose, to prevent development of resistant organisms, enhance adherence, and achieve optimum serum blood levels.
- Based dosages as weight changes.
- Directly Observed Therapy (DOT) is the international standard of care for all patients with TB disease particularly with intermittent regimens.
- Monthly medical examination is standard for all cases to assess disease process and medication toxicities.
- Liver function tests are only recommended for children with severe TB disease or history of liver disease.
- Treatment for MDR-TB (resistance to at least INH and RIF) is individualized and prolonged. Multiple second-line drugs are required for treatment. In such cases, consultation with an expert in MDR-TB is strongly recommended.
- The clinical manifestations and radiographic appearance of TB disease in children with HIV tend to be similar to those in immunocompetent children, but manifestations in these children can be more severe and unusual and can include extrapulmonary involvement. Optimal therapy has not been established; therapy should include at least 4 first-line drugs (INH, RIF, PZA, EMB) initially, and be continued for at least 9 months.