• 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

• Usually seen with Isoniazid, Rifampicin or Pyrazinamide therapy
• Routine measurement of liver function tests is not routinely necessary during therapy unless there’s 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