Guideline

Guidance for national tuberculosis programmes on the management of tuberculosis in children

Year of Publication

2014

Issuing Institution

WHO

Links

Google Scholar,WHO IRIS

Recommendations

25 included recommendations

Xpert MTB/RIF should be used rather than conventional microscopy and culture as the initial diagnostic test in children suspected of having multidrug-resistant tuberculosis (MDR-TB) or HIV-associated TB

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Xpert MTB/RIF may be used rather than conventional microscopy and culture as the initial test in all children suspected of having TB

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

Xpert MTB/RIF may be used as a replacement test for usual practice (including conventional microscopy, culture, and/or histopathology) for testing of specific non-respiratory specimens (lymph nodes and other tissues) from children suspected of having extrapulmonary TB

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

Xpert MTB/RIF should be used in preference to conventional microscopy and culture as the initial diagnostic test in testing cerebrospinal fluid specimens from children suspected of having TB meningitis

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Interferon-gamma release assays (IGRAs) should not replace the tuberculin skin test (TST) in low- and middle-income countries for the diagnosis of latent TB infection in children or for the diagnostic work-up of children (irrespective of HIV status) suspected of TB disease in these settings

Status

Retired

Recommended against

Strong

Certainty of evidence

Low

Commercial serodiagnostics should not be used in children suspected of active pulmonary or extrapulmonary TB, irrespective of their HIV status

Status

Maintained

Recommended against

Strong

Certainty of evidence

Very low

Routine HIV testing should be offered to all patients, including children, with presumptive and diagnosed TB

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

The following dosages of anti-TB medicines should be used daily for the treatment of TB in children: isoniazid (H) 10 mg/kg (range 7–15 mg/kg); maximum dose 300 mg/day rifampicin (R) 15 mg/kg (range 10–20 mg/kg); maximum dose 600 mg/day pyrazinamide (Z) 35 mg/kg (range 30–40 mg/kg) ethambutol (E) 20 mg/kg (range 15–25 mg/kg)

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Children with suspected or confirmed pulmonary TB or tuberculous peripheral lymphadenitis who live in settings with low HIV prevalence and/or low prevalence of isoniazid resistance and children who are HIV-negative, can be treated with a three-drug regimen (HRZ) for 2 months followed by a twodrug (HR) regimen for 4 months at the dosages specified in

Status

New

Recommended in favor

Strong

Certainty of evidence

Moderate

Children with suspected or confirmed pulmonary TB or tuberculosis peripheral lymphadenitis and/or children with extensive pulmonary disease, living in settings where the prevalence of HIV is high and/or the prevalence of isoniazid resistance is high should be treated with a four-drug regimen (HRZE) for 2 months followed by a two-drug regimen (HR) for 4 months at the dosages specified in Recommendation 8

Status

New

Recommended in favor

Strong

Certainty of evidence

Moderate

Infants aged 0–3 months with suspected or confirmed pulmonary TB or tuberculous peripheral lymphadenitis should be promptly treated with the standard treatment regimens, as described in recommendation 9 or 10. Treatment may require dose adjustment to reconcile the effect of age and possible toxicity in young infants. The decision to adjust doses should be taken by a clinician experienced in managing paediatric TB

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

During the continuation phase of treatment, thrice-weekly regimens can be considered for children known not to be HIV-infected and living in settings with well-established directly-observed therapy (DOT)

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

Streptomycin should not be used as part of first-line treatment regimens for children with pulmonary TB or tuberculous peripheral lymphadenitis

Status

New

Recommended against

Strong

Certainty of evidence

Moderate

Children with suspected or confirmed tuberculous meningitis and children with suspected or confirmed osteoarticular TB should be treated with a fourdrug regimen (HRZE) for 2 months, followed by a two-drug regimen (HR) for 10 months, the total duration of treatment being 12 months. The doses recommended for the treatment of tuberculous meningitis are the same as those described for pulmonary TB

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

Clinical evaluation of household and close contacts for active TB should be done on the basis of their risk for having or developing active TB or for the potential consequences of the disease if it develops. Priority should be given to contacts who are: - children with symptoms suggestive of TB; - children <5 years of age; - children with known or suspected immunocompromising conditions (especially those living with HIV); and - child contacts of index cases with multidrug-resistant or extensively drug-resistant TB (proven or suspected)

Status

New

Recommended in favor

Strong

Certainty of evidence

Very low

It is recommended that contact investigation be conducted for household and close contacts when the index case has any of the following characteristics: - has sputum smear-positive pulmonary TB; - has multidrug-resistant or extensively drug-resistant TB (proven or suspected); - is a person living with HIV; or - is a child <5 years of age

Status

New

Recommended in favor

Strong

Certainty of evidence

Very low

Contact investigation may be conducted for household and close contacts of all other index cases with pulmonary TB, in addition to the index cases covered in Recommendation 19

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

Children <5 years of age who are household or close contacts of people with TB and who, after an appropriate clinical evaluation, are found not to have active TB should be given 6 months of isoniazid preventive therapy (IPT) (10 mg/kg per day, range 7–15 mg/kg, maximum dose 300 mg/day)

Status

New

Recommended in favor

Strong

Certainty of evidence

High

In settings of high HIV prevalence, all household and close contacts of people with TB should be counselled and tested for HIV

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

In settings of low HIV prevalence, all household members and close contacts of people with TB who have symptoms compatible with TB disease may be offered counselling and testing for HIV as part of their clinical evaluation

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

All household contacts of an index case who is a person living with HIV should be counselled and tested for HIV

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Children living with HIV who are more than 12 months of age and who are unlikely to have TB disease on symptom-based screening and who have no contact with a TB case: should be offered 6 months of isoniazid preventive therapy (IPT) (10 mg/kg per day, range 7–15 mg/ kg, maximum dose 300 mg/day) as part of a comprehensive package of HIV prevention and care services if living in settings with a high TB prevalence

Status

New

Recommended in favor

Strong

Certainty of evidence

Low

Children living with HIV who are more than 12 months of age and who are unlikely to have TB disease on symptom-based screening and who have no contact with a TB case: might be offered 6 months of isoniazid preventive therapy (IPT) (10 mg/kg per day, range 7–15 mg/kg, maximum dose 300 mg/day) as part of a comprehensive package of HIV prevention and care services if living in settings with a medium or low TB prevalence

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

Children with suspected or confirmed pulmonary TB or tuberculous peripheral lymphadenitis living in settings with a high HIV prevalence (or with confirmed HIV infection) should not be treated with intermittent regimens (that is, twice-weekly or thrice-weekly doses)

Status

New

Recommended against

Strong

Certainty of evidence

Low

Children with proven or suspected pulmonary TB or tuberculous meningitis caused by multidrug-resistant bacilli can be treated with a fluoroquinolone in the context of a well-functioning MDR-TB control programme and within an appropriate multidrug-resistant tuberculosis (MDR-TB) regimen. The decision to treat should be taken by a clinician experienced in managing paediatric TB

Status

New

Recommended in favor

Strong

Certainty of evidence

Very low