moderate

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

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

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).

Three times weekly dosing throughout therapy [2(HRZE)3/4(HR)3] may be
used as another alternative to Recommendation 2.1, provided that every
dose is directly observed and the patient is NOT living with HIV or living in
an HIV-prevalent setting.

New patients with pulmonary TB may receive a daily intensive phase
followed by a three times weekly continuation phase [2HRZE/4(HR)3], provided that each dose is directly observed.

For smear-positive pulmonary TB patients treated with first-line drugs, sputum
smear microscopy may be performed at completion of the intensive phase of
treatment.

If a daily continuation phase is not possible for these patients, three times
weekly dosing during the continuation phase is an acceptable alternative.

WHO strongly recommends using LF-LAM to assist in the diagnosis of active TB in HIV-positive adults, adolescents and children irrespective of signs and symptoms of TB and with a CD4 cell count of less than 200 cells/mm3.

WHO strongly recommends using LF-LAM to assist in the diagnosis of active TB in HIV-positive adults, adolescents and children with advanced HIV disease or who are seriously ill.