HomeOnce drug susceptibilities of the source case’s or the child’s isolate are available, treatment can be modified. In general, the higher the bacillary burden, such as in cavitary cases or smear-positive cases, the greater the need for more drugs and longer duration of therapy to prevent drug resistance and achieve relapse-free cure.
For fully susceptible intrathoracic TB, INH, RMP and PZA should be used for the first 2 months, followed by 4 months of INH and RMP. If RMP or PZA are discontinued because of side effects, longer durations of therapy are required. RMP is a cornerstone of anti-TB therapy and should not be discontinued because of minor side effects. The minimum duration of therapy is 6 months total, similar to adult TB-treatment recommendations. A recently presented, open-label trial compared a total of 4 months of therapy (2 months of INH, RMP and PZA followed by 2 months of INH and RMP) to the standard 6-month regimen for children with smear-negative, non-severe disease; further data are awaited to determine non-inferiority.72 We continue to recommend a minimum of 6 months for treatment of childhood TB disease in Canada.
If hilar lymphadenopathy alone is present, treatment as for pulmonary TB disease should be used unless the isolate is resistant. Please see Chapter 5: Treatment of Tuberculosis Disease for further details on dosing frequency, treatment duration(s), drug side effects and management of side effects.
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