Children and Adolescents

For many years, ethambutol was not recommended for use in children aged under 5 years. The concern was that it might cause optic neuritis in children who were too young to report the early visual symptoms, which could lead to irreversible blindness. A review of pharmacokinetic and safety data on ethambutol in children concluded that the risk of ocular toxicity was negligible if recommended dosages were adhered to, especially considering the fact that the use of ethambutol is limited to the intensive phase of treatment (88, 89).

The 4-month regimen including rifapentine and moxifloxacin (2HPMZ/2HPM) may be selected for adolescents aged 12 years and over and weighing at least 40 kg with PTB, regardless of disease severity (88). The following factors should be considered before selecting this regimen:

Daily dosing throughout treatment in the intensive and continuation phases is recommended for all treatment regimens for drug-susceptible TB in children.

Young children with TB usually have paucibacillary TB disease (TB disease forms with a lower burden of M. tuberculosis than is typical in adult-type cavitary TB disease) and are at lower risk for transmitting TB to other children or adults (6). School-aged children and adolescents, however, may have bacteriologically confirmed TB, sometimes with cavities on CXR (6).

To achieve the goals of successful TB treatment in children and adolescents, clinical and programmatic management should include the following components and skills:

BCG in children living with HIV

BCG is a live attenuated bacterial vaccine derived from Mycobacterium bovis that was originally isolated in 1902 from a tuberculous cow. BCG has demonstrated significant effectiveness, but protection has not been consistent against all forms of TB in all age groups. BCG has also shown effectiveness in preventing leprosy (caused by Mycobacterium leprae) and Buruli ulcer (caused by Mycobacterium ulcerans) (31).

This annex provides information on administering, reading and interpreting tuberculin skin tests (TSTs).

A TST is the intradermal injection of a combination of mycobacterial antigens that elicit a delayed-type hypersensitivity immune response, represented by induration, which can be measured in millimetres.

Children with TBM should preferably be hospitalized for initiation of treatment and close monitoring. Children aged under 2 years with miliary TB should be evaluated for TBM regardless of the presence of CNS symptoms. If these children are not evaluated for TBM for any reason, extension of treatment to 12 months may be considered.