low

Children with suspected or confirmed osteoarticular tuberculosis 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 doses
recommended for the treatment of osteoarticular tuberculosis are the same as those
described for pulmonary tuberculosis.

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.

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.

Priority should be given to achieving adequate ACH using ventilation systems. However, in some settings it is not possible
to achieve adequate ventilation; for example, because of climatic changes (e.g. in winter or during the night) or building
structure, or because transmission of TB would pose a high risk of morbidity and mortality (e.g. in MDR-TB wards). In such
cases, a complementary option is to use upper room or shielded ultraviolet germicidal irradiation (UVGI) devices. This environmental control does not provide fresh air or directional airflow.

Well-designed, maintained and operated fans (mixed-mode ventilation) can help to obtain adequate dilution when natural
ventilation alone cannot provide sufficient ventilation rates.
In some settings, mechanical ventilation (with or without climate control) will be needed. This may be the case, for example,
where natural or mixed-mode ventilation systems cannot be implemented effectively, or where such systems are inadequate given local conditions (e.g. building structure, climate, regulations, culture, cost and outdoor air quality).

In existing healthcare facilities that have natural ventilation, when possible, effective ventilation should be achieved by
proper operation and maintenance on a regular schedule. Simple natural ventilation may be optimized by maximizing the
size of the opening of windows and locating them on opposing walls.

Adequate ventilation in healthcare facilities is essential for preventing transmission of airborne infections, and is strongly
recommended for controlling spread of TB. The choice of ventilation system will be based on assessment of the facility and
informed by local programmatic, climatic and socioeconomic conditions (refer to guideline for Controls 10a and 10b). Any ventilation system
must be monitored and maintained on a regular schedule. Adequate resources (budget and staffing) for maintenance are
critical.

Hospital stay is generally not recommended for the evaluation of people suspected of having TB or for the management of
patients with drug-susceptible TB, except in cases that are complicated or have concomitant medical conditions that require
hospitalization. If hospitalized, patients with TB symptoms should not be placed in the same area as susceptible patients
or infectious TB patients (see rest of the recommendation p. 12 of the guideline).

To minimize the spread of droplet nuclei, any coughing patient with a respiratory infection – in particular, patients with or
suspected of having TB – should be educated in cough etiquette and respiratory hygiene; that is, in the need to cover their
nose and mouth when sneezing and/or coughing (see rest of the recommendation p. 12 of the guideline).

It is also crucial to separate infectious patients after triage. The specific criteria (e.g. smear and culture status) for separating
patients will depend on the local settings and patient population. In particular, patients living with HIV or with strong clinical