Miliary TB In Children
Description Medicine Treatment ICD-10 code: A19.9 DESCRIPTION Miliary tuberculosis is a potentially fatal form of TB disease due to the spread of the organism in the bloodstream to the lungs, brain and other organs. Patients with miliary TB are assumed to have CNS involvement and are treated accordingly. MEDICINE TREATMENT Children < 8 years: The 75/50 RH and 75/50/150 RHZ formulations a
ICD-10 code: A19.9
DESCRIPTION
Miliary tuberculosis is a potentially fatal form of TB disease due to the spread of the organism in the bloodstream to the lungs, brain and other organs. Patients with miliary TB are assumed to have CNS involvement and are treated accordingly.
MEDICINE TREATMENT
Children < 8 years:
The 75/50 RH and 75/50/150 RHZ formulations are not suitable for achieving the required doses in miliary TB, TBM/CNS TB, so the 60/60 RH formulation should be used for such children.
A 6-month regimen of all 4 of the following medicines:
- Rifampicin, oral, 20 mg/kg as a single daily dose.
- Maximum dose: 600 mg daily.
PLUS
- Isoniazid, oral, 20 mg/kg as a single daily dose.
- Maximum dose: 400 mg daily.
PLUS
- Pyrazinamide, oral, 40 mg/kg as a single daily dose.
- Maximum daily dose: 2000 mg.
PLUS
- Ethionamide, oral, 20 mg/kg as a single daily dose.
- Maximum daily dose: 1000 mg.
Single phase of treatment, 6–9 months Once daily; 7 days a week
| Body weight |
Rifampicin/ Isoniazid (RH)
|
Pyrazinamide (Z)
|
Ethionamide (Eto)
|
| < 2 | Obtain Expert Advice | ||
| 2–2.9 | 3⁄4 tablet or 3 mL | 1 mL | 1.5 mL |
| 3–3.9 | 1 tablet or 4 mL | 2 mL | 2 mL |
| 4–4.9 | 1 1⁄2 tablets or 6 mL | 2.5 mL | 2.5 mL |
| 5–5.9 | 1 3⁄4 tablets or 7 mL | 3 mL | 3 mL |
| 6–6.9 | 2 tablets or 8 mL | 1⁄2 tablet or 4 mL | 1⁄2 tablet or 4 mL |
| 7–8.9 | 2 1⁄2 tablets or 10 mL | ||
| 9–9.9 | 3 tablets or 12 mL | 3⁄4 tablet or 6 mL | 3⁄4 tablet or 6 mL |
| 10–11.9 | 3 1⁄2 tablets or 14 mL | ||
| 12–12.9 | 4 tablets or 16 mL | 1 tablet or 8 mL | 1 tablet or 8 mL |
| 13–14.9 | 4 1⁄2 tablets or 18 mL | ||
| 15–16.9 | 5 tablets or 20 mL | 1 1⁄4 tablet or 10 mL | |
| 17–17.9 |
|
1 1⁄4 tablets or 18–19.9 | |
| 18–19.9 | 1 1⁄2 tablets or 12 mL | ||
| 20–24.9 | 6 tablets or 24 mL |
1 1⁄2 tablets or 12 mL |
|
Note:
Children should be taught and encouraged to swallow whole tablets or, if required, fractions of tablets so as to avoid large volumes of liquid medication if possible.
*If oral suspension required, for each dose, disperse 1 x HR 60/60 mg tablet in 4 mL of water, administer required dose as indicated in above chart, discard unused suspension.
**If oral suspension is required, crush 1 x 500 mg pyrazinamide tablet to a fine powder, disperse in 8 mL water to prepare a concentration of 500 mg/8 mL (62.5 mg/mL), administer required dose as indicated in above chart, discard unused suspension.
***If oral suspension is required, crush 1 x 250 mg ethionamide tablet to a fine powder, disperse in 8 mL of water to prepare a concentration of 250 mg/8 mL (31.3 mg/mL); administer required dose as indicated in above chart; discard unused suspension.
PLUS
- Pyridoxine 25 mg daily for 6 months.
Note:
All cases of miliary TB should have a lumbar puncture (LP) performed. Any abnormal CSF results, or where a LP is not performed, should be treated as a patient with TBM. See section 8.13: Meningitis, tuberculosis (TBM).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 10: Tuberculosis, 10.3 Miliary TB In Children