Children and Adolescents

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

Table A7.1. Options for neurocognitive and functional testing at end of treatment for TB meningitis

Methodology for developing the treatment decision algorithms

This annex provides an overview of respiratory and non-respiratory specimens that can be used to diagnose TB in children and adolescents, with a short description for each, the age group in which they can be used, the minimum volume required for testing, and the optimal time of collection.

Table A3.1. Respiratory specimens

Sensitivity for TB of “any abnormality” as reported on CXR in close contacts aged under 15 years is 84%, and specificity is 91% (25). It is thus more specific than symptom screening alone. Estimates of the accuracy of CXR are not disaggregated by age group, and significant differences in CXR findings between younger and older children may lead to important differences in sensitivity and specificity by age group.

TB contact investigation can be implemented at the health care facility or at the community level, or as a combination. This section contains some examples of approaches to contact investigation, including lessons learnt.

Contact investigation to identify children, adolescents and other household members with TB disease and to identify those who will benefit from TPT should be a standard component of all national TB programmes. Contact investigation is good public health practice and essential to address and manage several infectious diseases such as coronavirus disease 2019 (COVID-19).

Household contacts of people with PTB are a well-recognized group at risk for TB infection and TB disease, including prevalent TB detected at the time of initial contact investigation and incident TB that occurs within the subsequent 2–5 years (15). WHO recommends that household contacts and other close contacts of people with PTB should be systematically screened for TB disease (14). Contact investigation can be implemented at the health facility, in the community or through a combination of these approaches.