Operational Handbooks

5.2.7.1. Recommended dosages for first-line TB medicines

Table 5.3 shows the recommended dosages for first-line TB medicines for children. These dosages are applicable to all children, irrespective of the type of TB (except for TBM treated with the short intensive regimen) and HIV status. They also apply to the 12-month TBM regimen. Evidence on alternative compositions or dosages in the longer TBM regimen has not been assessed by WHO. For implications of interactions between ART and TB medicines, see Section 7.1 on TB/HIV coinfection.

5.2.3. Recommended regimens for treatment of drug susceptible pulmonary TB in children

As in adults, TB treatment in children and adolescents includes a 2-month intensive phase followed by a continuation phase of 2–4 months. In the intensive phase, TB bacilli are rapidly killed to prevent disease progression, transmission and development of drug resistance. In the continuation phase, dormant bacilli are eliminated to effect cure and prevent relapse. The choice of TB treatment regimen (including whether to include a fourth medicine – ethambutol – in the intensive phase) depends on the prevalence of HIV and isoniazid resistance in the setting, severity of disease and age.

4.3.1. Typical symptoms of pulmonary TB

In most cases, children with TB disease develop chronic unremitting symptoms that persist for more than 2 weeks without sustained improvement or resolution following treatment for alternative diagnoses (e.g. antibiotics for pneumonia, antimalarials for fever, nutritional rehabilitation for failure to thrive or malnutrition). The most common clinical presentation of PTB in children is persistent cough and poor weight gain. Figure 4.2 illustrates different cough patterns, which may be useful to visualize how a persistent, non-remitting cough presents.

3.3.5.2. Dosages

The WHO task force on pharmacokinetics and pharmacodynamics analysed available evidence from clinical trials of rifapentine and suggested a simplified dose for various weight bands for 3HP and 1HP for the 2020 WHO consolidated guidelines on tuberculosis. Module 1: prevention – tuberculosis preventive treatment (28). Table 3.2 presents standard dosing for the recommended TPT regimens by age and body weight.

3.3.5.1. Implementation considerations

The choice of TPT regimen depends on the age of the child, the HIV and ART status, and the availability and affordability of suitable (child-friendly) formulations.14 Rifampicin- and rifapentine-containing regimens should be prescribed with caution in children and adolescents living with HIV and on ART because of potential drug–drug interactions (see Section 7.1 and Tables 7.2 and 7.3). Table 3.1 summarizes the options for different target and age groups.