Treatment of tuberculosis in children.

PIP: Treatment guidelines for tuberculosis in children, issued by the International Union against Tuberculosis and Lung Diseases in 1987 and 1990 and the World Health Organization Tuberculosis Unit for the Treatment of Tuberculosis in Adults and Children in 1991, are explained. The combination drug treatments are similar to those recommended for adults, except that ethambutol is not normally given to children too young to have vision tests. Another difference is that the 2 or 3 times weekly dosing schedules are not usually followed in young children, because they cannot take so many tablets orally. The treatment schedule involves an initial intensive phase with 4 drugs, isoniazid, rifampicin, pyrazinamide, and streptomycin, followed by a consolidation phase lasting 6-8 months without pyrazinamide. Alternatively, a longer regimen without isoniazid taken for 4-8 months, can be used for the more common paucibacillary forms. In case of suspected cure failure or relapse, another regimen of 5 drugs must be restarted, including isoniazid, rifampicin, ethambutol, pyrazinamide, and streptomycin for 8 months. These multi-drug regimens are continued until definitive testing shows the TB is not resistant, when some drugs may be dropped. Aspects of management of the child's care are reviewed, such as types of clinical exams; family education; dosage; giving prednisone in cases of meningitis; miliary tuberculosis; serosis; or lobar, segmental, or bronchial involvement. Recommendations are given for supervision and delegation of drug administration; follow-up visits; treatment of localized TB in joints, pleura, or pericardium, and the importance of notification of childhood TB. These drug regimens, if followed, correctly, will cure TB in 100% of children, but the sequelae will depend on the extent of initial infection.^ieng

An Algerian experiment: short chemotherapy for tuberculosis.

PIP: 427 Algerian children aged up to 15 years were treated at the Pediatric Clinic of the Beni-Messour University Hospital Centre, Algiers, between July 1979-January 1985 with a 6-month multi-drug course for tuberculosis (TB). TB was diagnoses by clinical and x-ray findings in 56% and confirmed bacteriologically in the rest. Those with pulmonary, meningeal, osteoarticular, or renal TB received isoniazid and rifampicin daily for 6 months with streptomycin and pyrazinamide for the first 2 months. Those with primary TB, regional lymphadenitis, pleural, peritoneal, or other localized TB received the same drug regimen without initial streptomycin. 372 children completed the course, and, of these, all were cured, 99% definitely so. There were 3 relapses. Children who did not complete the drug treatment included 7 who died due to TB, 4 of them pulmonary and 3 meningeal; 1 who had drug toxicity; 17 who stopped treatment and were lost to follow-up; 30 who were lost to follow-up after completion of treatment and 5 who died of unrelated causes. The only adverse reactions were transient elevated liver transaminase in 4.6, and 1 case of jaundice in a child who received an accidental overdose. Besides its effectiveness, this short course treatment was considered beneficial because only 4% discontinued and were lost to follow-up, compared to 15% of a prior group given a 12-month treatment course.^ieng