Children and Adolescents

Co-trimoxazole is a broad-spectrum antimicrobial medicine that prevents a range of secondary bacterial and parasitic infections in eligible people living with HIV. Daily prophylaxis with CPT prolongs survival and reduces the incidence of comorbidities in children living with HIV. It also reduces the risk of coinfections such as pneumocystis pneumonia in infants exposed to HIV.

Children and adolescents living with HIV have an increased risk of TB exposure, infection, progression to disease, and TB-related morbidity and mortality. This risk is influenced by the degree of immune suppression. Childhood HIV infection is particularly common in settings where antenatal HIV prevalence is high and interventions for prevention of vertical transmission are not implemented widely. In these settings, the prevalence of HIV is particularly high among infants and young children, an age group that is also at risk for TB.

This chapter summarizes the treatment options available for children and adolescents to treat drug-susceptible TB and DR-TB and pulmonary and extrapulmonary forms of TB (including TBM), and considerations related to post-TB health. It includes operational guidance on various new treatment approaches, including a 4-month treatment regimen, and important implementation considerations such as availability of child-friendly formulations and access to all key medicines for the treatment of DR-TB.

The WHO task force on pharmacokinetics and pharmacodynamics analysed available evidence from clinical trials of rifapentine and suggested a simplified dose for various weight bands for 3HP and 1HP for the 2020 WHO consolidated guidelines on tuberculosis. Module 1: prevention – tuberculosis preventive treatment (28). Table 3.2 presents standard dosing for the recommended TPT regimens by age and body weight.

Table 3.2. Dosing for recommended TB preventive treatment regimens