Module 5: Management of tuberculosis in children and adolescents
Module 5: Management of tuberculosis in children and adolescents
Table of Content (Online Version) :
- Acknowledgments
- Abbreviations
- Definitions
- 1. Introduction
- 2. TB screening and contact investigation
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3. Prevention of TB in children and adolescents
- 3.1 Introduction
- 3.2 BCG vaccination
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3.3 TB preventive treatment
- 3.3.1. Introduction
- 3.3.2. Target groups for TB preventive treatment
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3.3.3. Ruling out TB disease before starting TB preventive treatment
- 3.3.3.1. HIV-negative household and close contacts of a person with pulmonary TB: infants and children aged under 5 years
- 3.3.3.2. HIV-negative household and close contacts of a person with pulmonary TB: children and adolescents aged 5 years and over
- 3.3.3.3. Children and adolescents living with HIV
- 3.3.4. Testing for TB infection
- 3.3.5. Options for TB preventive treatment regimens: drug-susceptible TB
- 3.3.6. Options for TB preventive treatment regimens: drug-resistant TB
- 3.3.7. Follow-up of children and adolescents on TB preventive treatment
- 3.3.8. Adherence to TB preventive treatment
- 3.3.9. Other issues related to TB preventive treatment in children and adolescents
- 3.4 TB infection prevention and control
- Key messages
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4. TB diagnostic approaches for children and adolescents
- 4.1 Introduction
- 4.2 Diagnosing TB in children and adolescents
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4.3 Diagnostic approaches: pulmonary TB
- 4.3.1. Typical symptoms of pulmonary TB
- 4.3.2. History of TB contact
- 4.3.3. Clinical examination
- 4.3.4. Atypical clinical presentations of children with pulmonary TB
- 4.3.5. Bacteriological confirmation
- 4.3.6. Testing for TB infection
- 4.3.7. Role of chest X-ray
- 4.3.8. HIV testing
- 4.3.9. Integrated treatment decision algorithms for pulmonary TB in children
- 4.4 Diagnostic approaches: extrapulmonary TB
- 4.5 Disease severity
- 4.6 Diagnostic approaches: drug-resistant TB
- Key messages
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5. Treatment of drug-susceptible and drug-resistant pulmonary and extrapulmonary TB in children and adolescents
- 5.1 Introduction
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5.2 Treatment of drug-susceptible TB in children and adolescents
- 5.2.1. Principles of TB management
- 5.2.2. Treatment of pulmonary TB in children and adolescents
- 5.2.3. Recommended regimens for treatment of drug susceptible pulmonary TB in children
- 5.2.4. Implementation considerations
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5.2.5. Subgroup considerations
- 5.2.5.1. Children with peripheral lymph node TB
- 5.2.5.2. Children and adolescents living with HIV
- 5.2.5.3. Children with severe acute malnutrition
- 5.2.5.4. Children with severe acute pneumonia
- 5.2.5.5. Infants aged under 3 months or weighing less than 3 kg
- 5.2.5.6. Children and adolescents treated for TB in past 2 years
- 5.2.5.7. Children and young adolescents with severe pulmonary TB
- 5.2.6. Treatment of drug-susceptible extrapulmonary TB in children and adolescents
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5.2.7. Recommended dosing of first-line medicines in children
- 5.2.7.1. Recommended dosages for first-line TB medicines
- 5.2.7.2. Dosage tables and formulations for treatment of drug-susceptible TB in children and adolescents
- 5.2.7.3. Dosing table for the short intensive TB meningitis regimen
- 5.2.7.4. Dosing of first-line medicines in older children and adolescents over 25 kg (excluding the short intensive TB meningitis regimen)
- 5.2.7.5. Pyridoxine supplementation
- 5.2.8. Additional management considerations
- 5.2.9. Nutritional support
- 5.2.10. Management of adverse events from medicines used to treat drug-susceptible TB
- 5.2.11. Treatment adherence
- 5.2.12. Follow-up and monitoring of children and adolescents on TB treatment
- Key messages: treatment of DS-TB
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5.3 Treatment of multidrug-resistant and rifampicin-resistant TB in children and adolescents
- 5.3.1. Identifying children who should be treated for multidrug-resistant and rifampicin-resistant TB
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5.3.2. Multidrug-resistant and rifampicin-resistant TB treatment regimens for children and adolescents
- 5.3.2.1. Overview and approach to selecting a treatment regimen
- 5.3.2.2. Shorter all-oral bedaquiline-containing regimen for multidrug-resistant and rifampicin-resistant TB in children
- 5.3.2.3. Longer individualized regimens for children with multidrug-resistant and rifampicin-resistant TB who are not eligible for the standardized all-oral bedaquiline-containing regimen
- 5.3.2.4. Practical approach to designing individualized multidrug-resistant and rifampicin-resistant TB treatment regimens
- 5.3.2.5. Special considerations: TB meningitis
- 5.3.2.6. Special considerations: TB/HIV coinfection
- 5.3.3. Dosing and formulations of second-line TB medicines in children and young adolescents
- 5.3.4. Monitoring of children and adolescents on multidrugresistant and rifampicin-resistant TB treatment
- Key messages: treatment of DR-TB
- 5.4 Practical guidance for assessment and management of post-TB health in children and adolescents
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6. Models of TB care for children and adolescents
- 6.1 Introduction
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6.2 Decentralized, family-centred, integrated TB services
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6.2.1. Implementation considerations
- 6.2.1.1. Stakeholder engagement
- 6.2.1.2. Regulatory framework and policy guidance
- 6.2.1.3. Health workforce
- 6.2.1.4. Treatment support
- 6.2.1.5. Recording and reporting
- 6.2.1.6. Access to diagnostic supplies and child-friendly formulations of TB medicines
- 6.2.1.7. Resource requirements
- 6.2.1.8. Opportunities for integration of TB services into other services
- 6.2.1.9. Socioeconomic impact of TB on children, adolescents and families
- 6.2.1.10. Examples of country experiences in development of family-centred, decentralized and integrated TB services for children and adolescents
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6.2.1. Implementation considerations
- 6.3 Private-sector involvement in care for children and adolescents with TB
- 6.4 Differentiated TB service delivery
- 6.5 TB and health emergencies
- Key messages
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7. Special situations
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7.1 Management of TB in children and adolescents living with HIV
- 7.1.1. Introduction
- 7.1.2. TB screening in children and adolescents living with HIV
- 7.1.3. Prevention of TB in children and adolescents living with HIV
- 7.1.4. Diagnosis of TB in children and adolescents living with HIV
- 7.1.5. Treatment of TB in children and adolescents living with HIV
- 7.1.6. Co-trimoxazole preventive therapy
- 7.1.7. Antiretroviral therapy
- 7.1.8. Immune reconstitution inflammatory syndrome
- 7.2 TB in pregnancy and management of newborns of mothers with TB disease
- 7.3 Palliative care for children and adolescents with TB
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7.4 Care for adolescents with or at risk of TB
- 7.4.1. Physical and mental health
- 7.4.2. Connectedness and positive contribution to society
- 7.4.3. Safety and a supportive environment
- 7.4.4. Learning, competence, education, skills and employability
- 7.4.5. Agency and resilience
- 7.4.6. Substance abuse and late presentation to care
- 7.4.7. Poor adherence
- 7.4.8. Making TB services more adolescent-friendly
- 7.5 TB in children with severe acute pneumonia
- 7.6 Management of children with TB and malnutrition
- Key messages
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7.1 Management of TB in children and adolescents living with HIV
- 8. References
- Annex 1. Selected resources on child and adolescent TB
- Annex 2. Tuberculin skin testing: administration, reading and interpretation
- Annex 3. Sample collection methods
- Annex 4. Standard operating procedures for sample collection methods
- Annex 5. Treatment decision algorithms
- Annex 6. Dosing of medicines used in second-line multidrug-resistant TB regimens by weight band (below 46 kg)
- Annex 7. Overview of options for neurocognitive and functional testing at end of treatment for TB meningitis
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