Tuberculosis%20-%20pulmonary%20(pediatric) Management

• Each patient should be assessed by individual country’s National Tuberculosis Program at the following intervals:
  • 2 weeks after initiation of treatment
  • At the end of intensive phase
  • Every 2 months until the completion of treatment
• Assessment during follow-up should include symptoms evaluation, treatment adherence assessment, adverse drug reactions & weight management
• Perform sputum smear at the end of the 2nd month in patient who was smear positive at diagnosis
• Repeat sputum exam should be performed at months 3 of therapy if sputum microscopy was positive at end of 2 months of treatment
  • Line probe assay or Xpert MTB/RIF for repeat exam is highly recommended
• Since patients have a slow radiological response to treatment, repeat chest X-ray is not routinely required
• Adverse drug reactions are less common compared in adults
• For patients on Ethambutol, monthly evaluations of visual acuity & color discrimination are advised

• Smear sputum microscopy & culture should be performed monthly until 3 consecutive negative results are obtained
• Follow-up sputum culture should be performed every 2-3 months

• Healthcare practitioners who are managing patients undergoing Isoniazid-Rifapentine combination therapy weekly for 12 weeks or 3 HP should:
  • Monitor all patients, prior to & during therapy for the the presence of active TB disease
  • Educate patients, parents or caretakers regarding side effects & advise them to immediately seek consultation upon recognition of such reactions (eg rashes, decrease in blood pressure & platelet count, as well as those that are drug allergy-related)
  • Evaluate patients monthly for treatment compliance & presence of side effects
  • Request for liver function tests (LFTs) (or at least an aspartate aminotransferase [AST]) in patients with liver disease, HIV, juvenile alcoholics & drug-users using injection paraphernalias or those who are taking medications with interactions with other drugs
  • Facilitate blood tests for patients with abnormal results & those who are prone to hepatic disorder
    • 3 HP regimen should be discontinued if AST result is ≥5x the upper limit of normal (ULN) with no concomitant symptoms or ≥3x ULN with accompanying symptoms
  • In the presence of severe adverse reactions, discontinue 3HP regimen & manage side-effects
    • 3 HP may be continued if adverse reactions are mild-moderate & tolerable, with continuous monitoring of patient status

• Usually seen with Isoniazid, Rifampicin or Pyrazinamide therapy
• Routine measurement of liver function tests is not usually necessary during therapy unless there is occurrence of jaundice, hepatomegaly or liver tenderness

• Commonly seen with Isoniazid therapy
• Oral Pyridoxine is recommended in the following patients: Severely malnourished, HIV-infected, breastfeeding & pregnant adolescents
  
  • Supplementation of 5-10 mg/day is recommended

• Associated with Rifampicin therapy
• Benign in nature; reassure patient & parent

• Prevents life-threatening forms of tuberculosis (TB)
  • Has significant protective effect of about 50-80% for disseminated or miliary disease
• Protective effect of BCG against pulmonary tuberculosis (PTB) is variable
• Not recommended in immunocompromised patients
• Multiple BCG vaccination is not recommended

Isoniazid Preventive Therapy

• Reduces the risk of developing PTB by ~90% with good adherence
• Recommended for patients <5 years of age presumed to have latent TB infection due to close contact with smear positive TB or human immunodeficiency virus (HIV) positive patient
• Recommended Isoniazid dosage is 10 mg/kg/day PO once daily x 6 months
• Follow-up is done every 2 months until treatment is complete
• The addition of Rifampicin in Isoniazid monotherapy given for 3 months has been shown to be as effective as Isoniazid monotherapy
• Isoniazid-Rifapentine combination, administered weekly for 12 weeks (3 HP) for the treatment of LTBI is approved for use in adults, patients 2-17 years of age, those who are afflicted with HIV & acquired immunodeficiency syndrome (AIDS) & are under ART which does not affect the actions of Rifapentine