About one million of TB cases by year still occur in children. TB childhood diagnosis is an urgent task and even suspected TB disease should also be treated. Clinical features; thorax-x-ray; TST; smear/culture/PCR from gastric aspirated-induced sputum are diagnosis tools.
Anti-TB drugs new doses in children, supported by pharmacokinetic (WHO):
Isoniazid (H) 10 mg/kg (10–15) max. 300 mg/day
Rifampicin (R) 15 (10–20) 600
Pyrazinamide (Z) 35 (30–40) 2000
Ethtambutol (E) 20 (15–25) 2500
All children have to be included in one of:
Exposure or Latent-TB-infection, or TB disease; because need different management. Although children, usually not been infectious, family prophylaxis interrupts disease’s dissemination.
TB exposure: H 2 months; repeat TST, if positive action as LTBI,
LTB infection: H 6–9 months or HR 3 months,
Children living in high-HIV-prevalence or high-H-resistance area, with pulmonary/lymphadenitis TB; or children with extensive pulmonary disease in low-HIV-prevalence o low-H-resistance area, should be treated: 2 months HRZE + 4 months HR. - In meningitis TB: 2HRZE + 10 HR. - HIV-negative children and low-HIV-prevalence and low-H-resistance area, could be treated: 2HRZ + 4HR. - Maintenance period: thrice-weekly regimens can be considered, only if well established Directly Observed Therapy. HIV-infected children or living in HIV-high-prevalence area should not be treated with intermittent regimens. - Streptomycin should not be used as a part of firs-line regimen in pulmonary/lymphadenitis TB. Children with TB-MDR should be treated: fluoroquinolones + aminoglucoside guide by an expert.