Active Disease in Children
- Regimens should include 4 different first-line anti-TB medications for the initial treatment of TB in children and adolescents.
- All patients should be started on INH, RIF, PZA and EMB unless there are contraindications, or if there is evidence of resistance to any of the drugs in the patient or source case.
- Pulmonary disease is treated for 6 months: the initial (2-month) phase employs 4 drugs (INH, RIF, PZA, and EMB) and the continuation (4-month) phase consists of INH and RIF. The fourth drug (EMB) is continued until drug susceptibility studies demonstrate that the isolate is susceptible to first-line agents. Initial treatment with INH, RIF, and PZA alone is adequate if a source case with pansensitive TB has been identified. Isolated hilar adenopathy can be treated with 6 months of INH and RIF alone when drug resistance is not a concern.
- Extrapulmonary disease is treated the same as pulmonary disease except for CNS or miliary TB which are treated for 9-12 months. After expert consultation, the 4th drug may be EMB, an aminoglycoside, or ethionamide. Steroids are indicated for CNS TB and can be considered for pericardial and pleural effusions, abdominal disease and severe miliary and endobronchial disease. For skeletal TB, orthopedic intervention and prolonged therapy may be indicated.