TB Manual

A diagnosis of TB disease in a young child, typically <5 years of age, should be considered a sentinel event and prompt the search for the source case, most likely an adult or adolescent in close contact with the child. Close caregivers should be promptly evaluated to rule out TB disease. To minimize nosocomial exposures upon admission of a child with suspected TB to a healthcare facility, parents/caregivers rooming in with the child should be assessed for TB symptoms and have a chest x-ray. Airborne precautions should be used until infectious TB is ruled out in both the patient and parents/caregivers (see Chapter 14: Prevention and Control of Tuberculosis Transmission in Healthcare Settings).

The principles and phases (intensive and continuation) of TB treatment are discussed in Chapter 5: Treatment of Tuberculosis Disease. A team approach is helpful in evaluating and treating children with TB disease. The team may include physicians, nurse practitioners, public health nurses, a social worker and an interpreter. Whenever possible, the team should include or involve a physician experienced with treating TB disease in children. Treatment is aimed at reducing morbidity and mortality, preventing acquired resistance and providing a lasting cure. Interruption of transmission is also important in adolescent patients with pulmonary TB who attend congregate settings, including schools. Prior to commencing therapy for TB disease, a baseline alanine aminotransferase and bilirubin level should be obtained. Human immunodeficiency virus (HIV) serology is recommended as standard of care for all children and adolescents being treated for TB disease, as TB is an opportunistic infection and the duration of treatment will be influenced by this result.

The most important element of the treatment of TB is the actual ingestion of the medication by the child.²⁴ Many children have difficulty with the pill burden and palatability. Child-friendly formulations in tablet form are available in many countries, avoiding the problems of compounding, but not in Canada.⁵⁹ In addition, some of these formulations are in fixed-dose combinations that are not recommended in Canada. If these fixed-dose combinations become available and are used (eg, for palatability), it should be with guidance from a pediatric TB specialist.

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