RetourAs in adults, TB treatment in children and adolescents includes an intensive phase of 2 months followed by a continuation phase of 2–4 months. In the intensive phase, tubercle bacilli are rapidly killed to prevent disease progression and transmission, and the development of drug-resistance. In the continuation phase, dormant bacilli are eliminated to effect cure and prevent relapse. The choice of TB treatment regimen depends on the severity of disease and age. The decision on whether to include a fourth medicine – ethambutol – in the intensive phase depends on the patient’s HIV status, or on the prevalence of HIV or isoniazid resistance in the setting. In children and adolescents aged between 3 months and 16 years with non-severe TB, a 4-month treatment course is recommended. This recommendation is based on the evidence from the SHINE trial, a large phase III trial to evaluate duration of TB treatment in children with non-severe drug-susceptible TB. The trial showed that a 4-month treatment regimen (2 months of isoniazid, rifampicin and pyrazinamide, with or without ethambutol, followed by 2 months of isoniazid and rifampicin, 2HRZ(E)/2HR) was non-inferior to the standard 6-month regimen (2 months of isoniazid, rifampicin and pyrazinamide, with or without ethambutol, followed by 4 months of isoniazid and rifampicin, 2HRZ(E)/4HR) (1, 31).
In children and adolescents between 3 months and 16 years of age with non-severe TB (without suspicion or evidence of MDR/RR-TB), a 4-month treatment regimen (2HRZ(E)/2HR) should be used. (Strong recommendation, moderate certainty of evidence) – new recommendation