WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents.

Year of Publication

Issuing Institution

Recommendations

47 included recommendations

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended against

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

Recommended in favor

Certainty of evidence

WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents.

Recommendations

In children and adolescents between 3 months and 16 years of age with non-severe TB (without suspicion or evidence of multidrug- or rifampicin-resistant TB (MDR/RR-TB), a 4-month treatment regimen isoniazid –rifampicin–ethambutol optional–pyrazinamide (2HRZ(E)/2HR) should be used.

In children with presumptive pulmonary TB attending health care facilities, integrated treatment decision algorithms may be used to diagnose pulmonary TB.

In children and adolescents between 3 months and 16 years of age with non-severe TB (without suspicion or evidence of multidrug- or rifampicin-resistant TB (MDR/RR-TB), a 4-month treatment regimen (2HRZ(E)/2HR) should be used.

In children with multidrug- or rifampicin-resistant TB (MDR/RR-TB) aged below 6 years, an all-oral treatment regimen containing bedaquiline may be used.

In children with multidrug- or rifampicin-resistant TB (MDR/RR-TB) aged below 3 years delamanid may be used as part of longer regimens.

In children and adolescents with bacteriologically confirmed or clinically diagnosed TB meningitis (without suspicion or evidence of MDR/RR-TB), a 6-month intensive regimen (6HRZEto) may be used as an alternative option to the 12-month regimen (2HRZE/10HR)

In high TB burden settings, decentralized TB services may be used in children and adolescents with signs and symptoms of TB and/or in those exposed to TB.

Family-centred, integrated services in addition to standard TB services may be used in children and adolescents with signs and symptoms of TB and/or those exposed to TB.

People living with HIV should be systematically screened for TB disease at each visit to a health facility

Household contacts and other close contacts of individuals with TB disease, including women in the postpartum period and newborns, should be systematically screened for TB disease

Systematic screening for TB disease should be conducted in prisons and penitentiary institutions

Among individuals aged 15 years and older in populations in which TB screening is recommended, systematic screening for TB disease may be conducted using a symptom screen, chest X-ray or molecular WHO-recommended rapid diagnostic tests, alone or in combination

Among individuals aged 15 years and older in populations in which TB screening is recommended, computer-aided detection software programmes may be used in place of human readers for interpreting digital chest X-rays for screening and triage for TB disease

Among adults and adolescents living with HIV, C-reactive protein with a cut-off of > 5 mg/L may be used to screen for TB disease

Among adults and adolescents living with HIV, chest X-ray may be used to screen for TB disease

Adult and adolescent inpatients with HIV in medical wards where the TB prevalence is > 10% should be tested systematically for TB disease with a molecular WHO-recommended rapid diagnostic test

Among individuals younger than 15 years who are close contacts of someone with TB, systematic screening for TB disease should be conducted using a symptom screen including any one of cough, fever or poor weight gain; or chest radiography; or both

Among children younger than 10 years who are living with HIV, systematic screening for TB disease should be conducted using a symptom screen including any one of current cough, fever, poor weight gain or close contact with a TB patient

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

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

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

Triage of people with TB signs and symptoms, or with TB disease, is recommended to reduce M. tuberculosis transmission to health workers (including community health workers), persons attending health care facilities or other persons in settings with a high risk of transmission.

Respiratory separation / isolation of people with presumed or demonstrated infectious TB is recommended to reduce M. tuberculosis transmission to health workers or other persons attending health care facilities

Prompt initiation of effective TB treatment of people with TB disease is recommended to reduce M. tuberculosis transmission to health workers, persons attending health care facilities or other persons in settings with a high risk of transmission

Respiratory hygiene (including cough etiquette) in people with presumed or confirmed TB is recommended to reduce M. tuberculosis transmission to health workers, persons attending health care facilities or other persons in settings with a high risk of transmission.

Upper-room germicidal ultraviolet (GUV) systems are recommended to reduce M. tuberculosis transmission to health workers, persons attending health care facilities or other persons in settings with a high risk of transmission.

Particulate respirators, within the framework of a respiratory protection programme, are recommended to reduce M. tuberculosis transmission to health workers, persons attending health care facilities or other persons in settings with a high risk of transmission.

Infants aged < 12 months living with HIV who are in contact with a person with TB and who are unlikely to have active TB on an appropriate clinical evaluation or according to national guidelines should receive TB preventive treatment.

All children living with HIV who have successfully completed treatment for TB disease may receive TB preventive treatment.

Children aged ≥ 5 years, adolescents and adults who are household contacts of people with bacteriologically confirmed pulmonary TB who are found not to have active TB by an appropriate clinical evaluation or according to national guidelines may be given TB preventive treatment

In selected high-risk household contacts of patients with multidrug-resistant tuberculosis, preventive treatment may be considered based on individualized risk assessment and a sound clinical justification.

People who are initiating anti-TNF treatment, or receiving dialysis, or preparing for an organ or haematological transplant, or who have silicosis should be systematically tested and treated for latent tuberculosis infection (LTBI).

Systematic latent tuberculosis infection (LTBI) testing and treatment may be considered for prisoners, health workers, immigrants from countries with a high TB burden, homeless people and people who use drugs.

Systematic latent tuberculosis infection (LTBI) testing and treatment is not recommended for people with diabetes, people who engage in the harmful use of alcohol, tobacco smokers and underweight people unless they also belong to other risk groups included in the above recommendations.

Chest radiography may be offered to people living with HIV on ART and preventive treatment be given to those with no abnormal radiographic findings

The absence of any symptoms of TB and the absence of abnormal chest radiographic findings may be used to rule out active TB disease among HIV-negative household contacts aged ≥ 5 years and other risk groups before preventive treatment.

Either a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) can be used to test for latent tuberculosis infection (LTBI)