Treatment of drug-susceptible tuberculosis in children^[1]

Diagnostic category, regimens, and indications	Regimen*^¶^Δ
	Intensive phase		Continuation phase
	Regimen	Duration	Regimen	Duration
Pulmonary TB: drug susceptible (presumed or confirmed)
Traditional 6-month regimen (daily)^[2] New smear-positive pulmonary TB New smear-negative pulmonary TB with extensive parenchymal involvement Severe concomitant HIV disease	Isoniazid Rifampin Pyrazinamide Ethambutol	2 months	Isoniazid Rifampin	4 months
Shortened 4-month traditional regimen (daily) Age 3 months to <16 years Nonsevere, smear-negative pulmonary TB	Isoniazid Rifampin Pyrazinamide Ethambutol (use according to local guidance)	8 weeks	Isoniazid Rifampin	8 weeks
Rifapentine-moxifloxacin-based regimen (daily) Age ≥12 years, body weight ≥40 kg Absence of extrapulmonary involvement	Isoniazid Rifapentine Moxifloxacin Pyrazinamide	8 weeks	Isoniazid Rifapentine Moxifloxacin	9 weeks
Extrapulmonary TB: drug susceptible (presumed or confirmed)
Traditional 6-month regimen (daily) Severe forms of extrapulmonary TB (not including meningitis or osteoarticular disease) Less severe forms of extrapulmonary TB (may omit ethambutol)	Isoniazid Rifampin Pyrazinamide Ethambutol	2 months	Isoniazid Rifampin	4 months
12-month regimen (daily) Meningitis Osteoarticular disease	Isoniazid Rifampin Pyrazinamide Ethambutol (or ethionamide or levofloxacin^◊)	2 months	Isoniazid Rifampin	10 months^[3]
6-month intensive regimen (daily)^§	Isoniazid Rifampin Pyrazinamide Ethionamide	6 months

TB: tuberculosis; HIV: human immunodeficiency virus.

* For infants and young children, isoniazid tablets and can be pulverized, and the contents of rifampin capsules can be suspended in a flavored liquid or sprinkled on semisoft foods. Pyridoxine (vitamin B6) supplementation is not routinely recommended for children receiving isoniazid but should be considered for exclusively breastfed infants, malnourished children or those with diets poor in pyridoxine, and children with HIV infection. The isoniazid/B6 suspension (available in the United States) uses a sorbitol base that can induce diarrhea, especially at higher doses.

¶ Direct observation of drug administration is strongly recommended.

Δ Refer to separate UpToDate tables for drug dosing.

◊ While ethambutol is recommended by the World Health Organization as the fourth drug to be used in this regimen, in practice, ethionamide or levofloxacin is used more commonly.

§ In children and adolescents with bacteriologically confirmed or clinically diagnosed TB meningitis (without suspicion or evidence of multidrug-resistant/rifampin-resistant-TB), the World Health Organization has endorsed a 6-month intensive regimen as an alternative option to the 12-month regimen.

References:

WHO Operational Handbook on Tuberculosis. Module 5: Management of tuberculosis in children and adolescents. Geneva: World Health Organization, 2022. https://www.who.int/publications/i/item/9789240046832 (Accessed on May 23, 2023).
American Academy of Pediatrics. Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, 2021.
Rapid Advice: Treatment of tuberculosis in children. World Health Organization, 2010. Available at: https://apps.who.int/iris/handle/10665/44444 (Accessed on May 25, 2022).

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Treatment of drug-susceptible tuberculosis in children[1]

Treatment of drug-susceptible tuberculosis in children^[1]