SHORT-COURSE THERAPY FOR TUBERCULOSIS IN INFANTS AND CHILDREN

Objective: To improve efficacy of and compliance with therapy for tube rculosis in children. Options: Short-course (6-month) multi-drug thera py, either nonsupervised or directly supervised, versus long-course (m ore than 6-month) multi-drug therapy. Outcomes: Success (more than 90% of cases cured without relapse or serious side effects), development of drug resistance and compliance with treatment. Evidence: Review of published reports of efficacy trials of tuberculosis therapy in childr en, side effects and compliance studies; consensus of expert opinion. Values: Values were assigned to the evidence by the Infectious Disease and Immunization Committee of the Canadian Paediatric Society through review of the data and consensus. Benefits, harms and costs: Improved efficacy and compliance with short-course protocols should lower the rate of treatment failure among children in Canada and the cost of tub erculosis care. Recommendations: A short-course (6-month) protocol of four drugs for the first 2 months and two drugs for the subsequent 4 m onths is recommended to treat pulmonary tuberculosis dr extrapulmonary disease causing lymphadenopathy. Tuberculous meningitis, disease invo lving bones and joints and tuberculosis with HIV infection require lon ger courses of treatment. Asymptomatic tuberculosis should be treated with daily doses of isoniazid for 9 months. Intermittent directly obse rved therapy is recommended if compliance cannot be ensured. Routine l iver function testing is not recommended for prepubescent children lak ing isoniazid, but monthly assessment for clinical symptoms and period ic liver function evaluation is advised in adolescent women, especiall y post partum. Validation: This report was reviewed by the directors o f the Canadian Paediatric Society, the Hepatitis and Special Pathogens Division of the Laboratory Centre for Disease Control and the Canadia n Thoracic Society. The recommendations are similar to those of the Am erican Academy of Pediatrics. Sponsor: The recommendations were develo ped and endorsed by the Infectious Disease and Immunization Committee of the Canadian Paediatric Society.