TREATMENT
| CLASS | TYPE | DESCRIPTION |
| Group 0 | No TB exposure, not infected | No Hx of exposure, Tuberculin skin test (TST) -ve |
| Group 1 | TB exposure, no evidence of infection | Hx of exposure, TST -ve |
| Group 2 | TB infestion, no disease | +ve TST, Neg bacteriology, no clinical or radiological |
| Group 3 | Current TB disease | M. Tuberculosis culture or +ve tST and clinical or radiological |
| Group 4 | Previous TB | Hx of propr episode(s) of TB or abnormal but stable radiological; +ve TST; Neg bacteriology and no clinical or radiological |
| Group 5 | TB suspected, diagnosis pending | Suspected on clinical or radiological -ve TST, neg or unknown results |
Group 0: no exposure, not infected
– BCG where the prevalence of TB is high (unless HIV disease)
Group 1: exposed, no evidence of infection
– Assumed to be infected and offered preventing therapy.
– Repeat TST after 8-12 weeks; if negative and the child is well and no longer exposed you can stop therapy.
Group 2: TB infection no disease
– Risk is greatest in the first 2year and in children <5 years with up to 50% < 2 years developing the disease
– Isoniazid for 6-9 months .This reduces the risk of TB by 90%.
Group 3: Current TB
– 6 months therapy using isoniazid, rifampicin; pyrazinamide for 2 months.
– If pyrazinamide cannot be used, the 9 months regimen should be applied.
– If drug resistance is possible, add ethambutol or streptomycin.
Group 4: Previous TB disease:
– a) If completed a full course of chemotherapy: Discharge
– b) if previously untreated TB: Treatment as current TB
Group 5: TB suspected, diagnosis pending
– Treatment as current disease.
– Review within 10-14 days if no improvement
– Repeat TST after 4-6 weeks: if negative the diagnosis should be reviewed.
EXTRAPULMONARY TB:
Same regimen except meningitis
Corticosteroids
Indication:
TB meningitis, TB pericarditis, Large serous TB pleural effusion in
older children, and Symptomatic airway obstruction (tuberculous lymph
nodes).
–
Prednisolone
2mg /kg/ day is the usual dose.
Chemo
prophylaxis
Primary chemo prophylaxis is drug therapy to prevent infection.
Secondary chemo prophylaxis is drug therapy in persons with latent
M.tuberculosis infection to prevent disease. Positive TST in the absence
of clinical or radiological signs is taken as latent infection.
Without preventive therapy about 1 in 10 of those infected will
develop TB, half within 5 years of infection, and mainly within the
first 2 years. The risk of developing disease is highest in infants
and children younger than 4 years old. Even if the TST and chest x-ray
do not suggest TB, Infants who are close contacts of patient with infectious
pulmonary TB should receive prophylaxis.
The American Academy of Pediatrics recommends 6 months of daily
therapy with isoniazid (source susceptible) or rifampicin (source isoniazid
resistant) or if daily therapy is not possible, twice - weekly therapy
for 9 months. For children with HIV infection, a minimum of 12 months
is recommended.
The
control of TB still relies on a high index of suspicion to make the
diagnosis and motivated individuals working in a team to ensure compliance
with treatment.
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