Children and Adolescents

Children who are not eligible for the standardized all-oral bedaquiline-containing regimen include those without bacteriological confirmation (e.g. with a clinical diagnosis); or without fluoroquinolone resistance ruled out (in their own specimens); or with drug-resistant EPTB other than peripheral lymphadenopathy; or with extensive pulmonary disease; or with prior exposure for more than 1 month to the medicines in the shorter regimen.

The standardized shorter all-oral bedaquiline-containing regimen may now be used in children of all ages under programmatic conditions.¹⁷ The eligibility criteria for this regimen for children with confirmed MDR/RR-TB are the same as for adolescents and adults:

This section describes a practical approach to the treatment of children with rifampicin-resistant tuberculosis (RR-TB) and MDR-TB (resistant to both rifampicin and isoniazid). It covers identifying children who should be treated for MDR/RR-TB, deciding on the most appropriate treatment regimen, monitoring, and other implementation issues related to treatment.

Interruption in the treatment of drug-susceptible TB should be managed carefully. The duration, time on treatment at which the interruption occurs, and bacteriological status of the child or adolescent before and after the interruption should be considered. Table 5.10 has been modified from existing medical society guidelines to show the management of treatment interruption (109).

All patients and caregivers should be counselled to return to the clinic if there is a recurrence of TB symptoms after successful completion of treatment. Children and adolescents may experience a relapse of TB disease or reinfection. Scheduled clinical monitoring is not required for children or adolescents after successful completion of a 6-month course of drug-susceptible TB treatment.

All children and adolescents initiated on TB treatment should undergo a monitoring assessment at the following intervals as a minimum:

Children and adolescents with TB, their parents, other family members and other caregivers should receive education about TB and the importance of completing treatment. Especially for younger children, the support of their parents, caregivers and immediate family is important for successful treatment. In many settings, HCWs can observe or administer treatment to children or adolescents.

Early signs of ethambutol toxicity can be tested in older children using a colour perception test for red–green colour deficiencies (e.g. Ishihara test cards). Monitoring for optic neuritis can be sought early when there is clinical concern.