Children and Adolescents

Pyridoxine (vitamin B6) supplementation is recommended in children and adolescents living with HIV and in malnourished children and adolescents who are treated for TB, at a dosage of 0.5–1 mg/kg/day. Children weighing up to 25 kg receive half a 25 mg tablet or quarter of a 50 mg tablet (6). Supplementation with pyridoxine aims to prevent symptomatic pyridoxine deficiency, which presents as peripheral neuropathy, especially in children with severe malnutrition and children living with HIV.

For children and adolescents weighing 25 kg or over, adult guidance and dose recommendations should be followed. These children and adolescents can be treated with adult formulations.

The recommended dosages by weight band for the 6-month intensive regimen (6HRZEto) to treat bacteriologically confirmed or clinically diagnosed TBM (without suspicion or evidence of MDR/RR-TB) in children and adolescents weighing less than 35 kg are shown in Table 5.6. These dosages were developed to limit formulation manipulation (splitting tablets), top-up with standalone medicines, number of weight bands and pill burden.

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.