immune reconstitution syndrome. Treatment for
tuberculosis should not routinely exceed 6 months in
children who are HIV-positive, unless the tuberculosis has
central nervous system involvement, in which case
treatment should not routinely extend beyond 12 months.
Infection may also be caused by other mycobacteria e.g.M.
aviumcomplex, in which case specialist advice on
management is needed.Extrapulmonary tuberculosis
Central nervous system tuberculosis
Children with central nervous system tuberculosis should be
offered rifampicin, ethambutol hydrochloride, pyrazinamide
and isoniazid (with pyridoxine hydrochloride) for two
months. After completion of the initial treatment phase,
rifampicin and isoniazid (with pyridoxine hydrochloride)
should be continued for a further 10 months. Treatment for
tuberculosis meningitis should be offered if clinical signs and
laboratoryfindings are consistent with the diagnosis, even if
a rapid diagnostic test is negative.
An initial high dose dexamethasone p. 439 or prednisolone
p. 442 should be started at the same time as antituberculosis
therapy and then slowly withdrawn over 4 – 8 weeks.
Referral for surgery should be considered only in children
who have raised intracranial pressure.Pericardial tuberculosis
An initial high dose of oral prednisolone should be offered to
children with active pericardial tuberculosis at the same time
as initiation of antituberculosis therapy; it should then be
slowly withdrawn over 2 – 3 weeks.Latent tuberculosis
Clinicians should be aware that some groups of children with
latent tuberculosis are at increased risk of developing active
tuberculosis (such as children who are HIV-positive, diabetic
or receiving treatment with a tumour necrosis factor alphainhibitor). These children and their carers should be advised
of the risks and symptoms of active tuberculosis.Close contacts
All children who are a close contact (prolonged, frequent or
intense contact, e.g. household contacts or relations) of a
person with confirmed pulmonary or laryngeal tuberculosis
should be tested for latent tuberculosis. Children under
2 years should be assessed by a specialist.
Immunocompromised
Children in whom latent tuberculosis is suspected and who
are anticipated to be, or who are currently
immunocompromised (for example, if they are from a high
incidence country or have been in close contact with people
with suspected infectious or confirmed pulmonary or
laryngeal tuberculosis), should be referred to a tuberculosis
specialist.
Chemoprophylaxis for latent tuberculosis
Neonates who have been in close contact with a person with
tuberculosis which has not yet been treated for at least two
weeks, should be treated with isoniazid p. 367 (with
pyridoxine hydrochloride p. 627 ) followed by a Mantoux test
after six weeks of treatment. If the test is positive (and active
tuberculosis is not present) treatment should be continued
for six months; if negative (and confirmed by a negative
interferon-gamma release assay), the treatment should be
stopped and a BCG vaccination given.
Children aged 4 weeks to 2 years who have been in close
contact with a person with tuberculosis which has not been
treated for at least two weeks, should be treated with either
isoniazid (with pyridoxine hydrochloride) alone for six
months (preferred regimen if interactions with rifamycins
are a concern) or rifampicin p. 364 and isoniazid (with
pyridoxine hydrochloride) for three months (recommended
when hepatotoxicity is a concern); and then have a Mantoux
test. If the test is positive (and active tuberculosis is not
present), the treatment course should be completed. If the
test is negative, treatment should be continued and re-Recommended dosage for standard unsupervised 6 -month treatmentIsoniazid Child: 10 mg/kg once daily (max. per dose 300 mg) for 6 months (initial and continuation phases)
Rifampicin Child:
▶body-weight up to 50 kg: 15 mg/kg once daily for 6 months (initial and continuation phases);
maximum 450 mg per day;
▶body-weight 50 kg and above: 15 mg/kg once daily for 6 months (initial and continuation phases);
maximum 600 mg per day
Pyrazinamide Child:
▶body-weight up to 50 kg: 35 mg/kg once daily for 2 months (initial phase); maximum 1. 5 g per day;
▶body-weight 50 kg and above: 35 mg/kg once daily for 2 months (initial phase); maximum 2 g per day
Ethambutol hydrochloride Child: 20 mg/kg once daily for 2 months (initial phase)
In general, doses should be rounded up to facilitate administration of suitable volumes of liquid or an appropriate strength of tablet. The exception is
ethambutol hydrochloride due to the risk of toxicity. Doses may also need to be recalculated to allow for weight gain in younger children.
The fixed-dose combination preparations (Rifater®,Rifinah®) are unlicensed for use in children. Consideration may be given to use of these preparations
in older children, provided the respective dose of each drug is appropriate for the weight of the child.Recommended dosage for intermittent supervised 6 -month treatmentIsoniazid Child: 15 mg/kg 3 times a week (max. per dose 900 mg) for 6 months (initial and continuation phases)
Rifampicin Child: 15 mg/kg 3 times a week (max. per dose 900 mg) for 6 months (initial and continuation phases)
Pyrazinamide Child:
▶body-weight up to 50 kg: 50 mg/kg 3 times a week (max. per dose 2 g 3 times a week) for 2 months
(initial phase);
▶body-weight 50 kg and above: 50 mg/kg 3 times a week (max. per dose 2. 5 g 3 times a week) for
2 months (initial phase)
Ethambutol hydrochloride Child: 30 mg/kg 3 times a week for 2 months (initial phase)
In general, doses should be rounded up to facilitate administration of suitable volumes of liquid or an appropriate strength of tablet. The exception is
ethambutol hydrochloride due to the risk of toxicity. Doses may also need to be recalculated to allow for weight gain in younger children.
The fixed-dose combination preparations (Rifater®,Rifinah®) are unlicensed for use in children. Consideration may be given to use of these preparations
in older children, provided the respective dose of each drug is appropriate for the weight of the child.362 Bacterial infection BNFC 2018 – 2019
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