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40 Update on Tuberculosis for the General Paediatrician
  1. MJ Mellado
  1. Pediatric Infectious and Tropical Diseases, Hospital Carlos III. Servicio de Pediatria, Madrid, Spain

Abstract

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.

Children Key-recommendations:

  1. 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

  2. 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.

  3. TB management:

    1. TB exposure: H 2 months; repeat TST, if positive action as LTBI,

    2. LTB infection: H 6–9 months or HR 3 months,

    3. TB disease:

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.

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