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

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

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

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

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

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

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

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

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

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)

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

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

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)

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

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)