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The use of FDC child-friendly tablets is recommended instead of separate formulations in the treatment of children with drug-susceptible TB (100). FDC tablets have advantages over single medicines as they reduce the pill burden and the likelihood of prescription errors. By reducing selective non-adherence, FDC tablets can reduce the risk of development of drug resistance.
Table 5.3 shows the recommended dosages for first-line TB medicines for children. These dosages are applicable to all children, irrespective of the type of TB (except for TBM treated with the short intensive regimen) and HIV status. They also apply to the 12-month TBM regimen. Evidence on alternative compositions or dosages in the longer TBM regimen has not been assessed by WHO. For implications of interactions between ART and TB medicines, see Section 7.1 on TB/HIV coinfection.
The clinical presentation of DR-TB in a child or adolescent is similar to that of other forms of TB in a child or adolescent. When DR-TB is suspected, it is important to collect respiratory samples (stool, expectorated or induced sputum, NPA sample or gastric aspirate) for bacteriological confirmation by Xpert MTB/RIF or Xpert Ultra when possible. Truenat MTB or MTB Plus may also be used for sputum specimens. Xpert and
In children and adolescents, severity of TB disease ranges from mild to severe. Children with nonsevere, drug-susceptible TB are now eligible to receive a shortened 4-month treatment regimen. For consideration of a 4-month treatment regimen for non-severe, drug-susceptible PTB in children and young adolescents aged 3 months to 16 years, non-severe TB is defined based on the clinical presentation of disease as assessed through physical examination and CXR.
EPTB refers to any bacteriologically confirmed or clinically diagnosed case of TB involving organs other than the lungs (e.g. pleura, peripheral lymph nodes, abdomen, genitourinary tract, skin, joints and bones, meninges) (71). The classification of intrathoracic lymphadenopathy in children was updated following an expert consultation in September 2021 as PTB. EPTB is common in young children and in children and adolescents living with HIV.
In children with presumptive PTB attending health care facilities, integrated treatment decision algorithms may be used to diagnose PTB. This is an interim conditional recommendation valid until 2024, after which new evidence will be reviewed (see Box 4.6).
Routine HIV testing should be offered to all children and adolescents completing evaluation for exposure to TB, with presumptive TB or diagnosed with TB. Early and accurate detection of HIV infection is important to support the integrated management of TB/HIV coinfection. All children and adolescents with HIV-associated TB are eligible for ART and co-trimoxazole prophylaxis (6, 78).
CXR remains an important tool in the diagnosis of TB in children, especially those with negative bacteriological tests or where bacteriological testing is not available or not feasible. Most children with PTB have radiographic changes suggestive of TB. If possible, anteroposterior and lateral films should be obtained in children aged under 5 years, and posteroanterior films in older children and adolescents.
Abnormalities on CXR suggestive of PTB include:
