Monitoring
- 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
Prevention
Vaccination
Bacille-Calmette-Guerin (BCG)
Bacille-Calmette-Guerin (BCG)
- 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