HomeA decision to initiate treatment in a patient for TB disease implies a decision to monitor adherence, manage side effects, minimize risks of toxicity and ensure therapy is completed. All jurisdictions should have the capacity to provide daily, in person, comprehensive treatment support for children and adolescents with TB disease. The level and intensity of daily support should be individualized and may include DOT (see Chapter 5: Treatment of Tuberculosis Disease). If clinicians cannot provide this level of care, then they should refer the patient to programs that have this capacity. All patients should receive counseling about side effects and medication administration, and be provided with clinic contact information should side effects develop before the next scheduled appointment. Potential language and social barriers should be anticipated and appropriate accommodations be made to facilitate access to TB services. If DOT is used, it involves much more than simple observation of pills taken. Integrating a liaison public health nurse into the treatment team can facilitate medication administration, monitoring and follow-up for patients.
Although therapy generally is taken 7 days per week, it can also be taken as 5 observed doses per week. DOT is recommended for:
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disease due to suspected or proven drug-resistant strains;
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HIV co-infection or other significant immunocompromising condition;
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previous treatment failure for TB disease;
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re-treatment of disease;
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suspected nonadherence or previous nonadherence;
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reasonable doubts about the ability of the parents/guardians to supervise treatment for children;
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substance abuse in an adolescent; and
For those not receiving daily direct observation, regular follow-up and supervision may help detect side effects, administration errors and barriers to adherence (see also Chapter 5: Treatment of Tuberculosis Disease).
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