Children with suspected or confirmed tuberculous meningitis should be treated with a
four-drug regimen (HRZE) for 2 months, followed by a two-drug regimen (HR) for
10 months; the total duration of treatment being 12 months. The dosages
recommended for the treatment of tuberculous meningitis are the same as those
described for pulmonary tuberculosis.

Streptomycin should not be used as part of first-line treatment regimens for children
with pulmonary tuberculosis or tuberculous peripheral lymphadenitis.

Infants (aged 0–3 months) with suspected or confirmed pulmonary tuberculosis or
tuberculous peripheral lymphadenitis should be promptly treated with the standard
treatment regimens, as described above.

During the continuation phase of treatment, thrice-weekly regimens can be considered
for children known to be HIV-uninfected living in settings with well-established
directly-observed therapy (DOT).

Children with suspected or confirmed pulmonary tuberculosis or tuberculous
peripheral lymphadenitis living in settings with high HIV prevalence (or with
confirmed HIV infection) should not be treated with intermittent regimens (that is,
twice-weekly or thrice-weekly doses).

Children with suspected or confirmed pulmonary tuberculosis or tuberculous
peripheral lymphadenitis who live in settings with low HIV prevalence or low
resistance to isoniazid and children who are HIV-negative can be treated with a threedrug regimen (HRZ) for 2 months followed by a two-drug (HR) regimen for 4 months at the following dosages:
isoniazid (H) – 10 mg/kg (range 10–15 mg/kg); maximum dose 300 mg/day
rifampicin (R) – 15 mg/kg (range 10–20 mg/kg); maximum dose 600 mg/day
pyrazinamide (Z) – 35 mg/kg (30–40 mg/kg).

Children living in settings where the prevalence of the HIV is high or where
resistance to isoniazid is high, or both, with suspected or confirmed pulmonary
tuberculosis or peripheral lymphadenitis; or children with extensive pulmonary
disease living in settings of low HIV prevalence or low isoniazid resistance, should be
treated with a four-drug regimen (HRZE) for 2 months followed by a two-drug
regimen (HR) for 4 months at the following dosages:
isoniazid (H) – 10 mg/kg (range 10–15 mg/kg); maximum dose 300 mg/day

Children with proven or suspected pulmonary tuberculosis or tuberculous meningitis
caused by multiple drug-resistant bacilli can be treated with a fluoroquinolone in the
context of a well-functioning MDR-TB control programme and within an appropriate
MDR-TB regimen. The decision to treat should be taken by a clinician experienced in
managing paediatric tuberculosis.

Given the risk of drug-induced hepatotoxicity, WHO recommends the following
dosages of antituberculosis medicines for the treatment of tuberculosis in children:
isoniazid (H) – 10 mg/kg (range 10–15 mg/kg); maximum dose 300 mg/day
rifampicin (R) – 15 mg/kg (range 10–20 mg/kg); maximum dose 600 mg/day
pyrazinamide (Z) – 35 mg/kg (30–40 mg/kg)
ethambutol (E) – 20 mg/kg (15–25 mg/kg).

For the continuation phase, the optimal dosing frequency is also daily for these
patients.