Treatment of paediatric TB: first-line TB regimen

Clinical description

The following are the dosage of anti-TB drugs for children. It is important to monitor the child’s weight at every clinic visit and to adjust drug doses accordingly. Many children rapidly gain weight after initiation of TB treatment.

Table 5.3-1: Paediatric TB drug dosages Drug name Dosage Isoniazid (H) 10mg/kg (range 10-15mg/kg); max dose 300mg/day Rifampicin (R) 15mg/kg (range 10-20 mg/kg); max dose 600 mg/day Pyrazinamide (Z) 35 mg/kg (range 30-40mg/kg)

Ethambutol (E) 20mg/kg (range 15-25mg/kg)

In the period of implementing this guideline the following fixed dose combination (FDC) drugs will be used, but new FDC drugs will be introduced in 2017.

Table 5.3-2: Older Fixed dose combination for TB in children (new TB cases)

Body weight Intensive phase 2 months Continuation phase Tablets Tablets Tablets Tablets kg R H Z R H E100 R H 60 30 150 60 60 60 60 5 to 7 1 1 1 1 8 to 14 2 1 2 1 15 to 20 3 2 3 2 21 to 30 USE 2 ADULT USE 2 ADULT 2 2 RHZE RHZE Table 5.3-3 below shows the new FDCs for children that will be introduced in 2017 in a phased manner:

Table 5.3-3: New FDCs for children with newly diagnosed TB Number of tablets Number of tablets Weight range Intensive phase E100 Continuation phase RHZ75/50/150 RH 75/50 4-7 kg 1 1 1 8-11 kg 2 2 2 12-15 kg 3 3 3 16-24 kg 4 4 4 25+ kg Adult dosage recommended 46 National Tuberculosis Control Programme FDC drugs were introduced recently by WHO. The following will be benefits of these new drugs:

• The right medicines in the right doses will increase adherence and save more lives. This

is an important step in improving treatment and child survival from TB and slowing the spread of drug-resistant TB.

• Simple TB medicines for children eases the TB burden on healthcare systems. Using FDCs

for children eases procurement of TB medicines. Fewer pills will simplify ordering and storage and facilitate the scale-up of paediatric treatment.

• Child-friendly medicines improve the daily lives of children and their families struggling

with TB. Six months is a long time to take medicine. But the availability of treatment that tastes good and is simple to provide will ease the daily struggles of children, parents and caregivers.

Table 5.3-4: Treatment guidelines for paediatric TB patients with specific TB disease Site or type of TB disease HRZE (intensive treatment RH (treatment Total treatment duration) duration) duration TB meningitis 2 months 10 months 12 months Miliary TB, osseous / bone TB Pulmonary TB, TB 2 months 4 months 6 months lymphadenitis ALL other forms of TB In TB meningitis and pericardial effusion, steroids have a supportive therapeutic effect.

• Prednisolone dosage (first-line): 2-4 mg/kg/day (maximum dose of 40 mg) for three

weeks, followed by a reduction regimen over three weeks.

• Pyridoxine (vitamin B6) protects against INH-induced peripheral neuropathy.

Pyridoxine is recommended for all children on TB treatment and IPT. The recommended dose is 25 mg/ day until treatment is completed.