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

Children with proven or suspected pulmonary tuberculosis or tuberculous meningitis
caused by multiple drug-resistant bacilli can be treated with a fluoroquinolone in the
context of a well-functioning MDR-TB control programme and within an appropriate
MDR-TB regimen. The decision to treat should be taken by a clinician experienced in
managing paediatric tuberculosis.

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).

For the continuation phase, the optimal dosing frequency is also daily for these
patients.

TB patients with known positive HIV status and all TB patients living in HIV prevalent settings should receive daily TB treatment at least during the intensive phase.

New patients with TB should not receive twice weekly dosing for the full course
of treatment unless this is done in the context of formal research.

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.

Wherever feasible, the optimal dosing frequency for new patients with pulmonary TB is daily throughout the course of therapy.

The 2HRZE/6HE treatment regimen should be phased out.