TB Chemoprophylaxis/ Isoniazid Preventive Therapy (IPT) in Children

Medicine Treatment 

Referral

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Z20.1

Consider TB chemoprophylaxis/isoniazid preventive therapy (IPT) in all children younger than 5 years, or who are living with HIV, and exposed to a pulmonary TB  contact

Exclude active TB (i.e. no signs or symptoms suggestive of TB):

• Refer to Pulmonary Tuberculosis in Children
• If any signs or symptoms of pulmonary TB are present, refer for chest X-ray
• Never give TPT to children with active TB

TB chemoprophylaxis/ IPT is only used in:

• Children <5 years of age

OR

• Children of any age, who are living with HIV

WITH EITHER

• Close contact with an infectious pulmonary TB case. If child is re-exposed to a close contact, TB chemoprophylaxis must be repeated (Previous IPT does not protect the child against subsequent TB exposure/ infection)
• Positive TST (only applicable on the first occasion of a positive TST)

MEDICINE TREATMENT

Preventative therapy in case of a drug-sensitive TB contact:

• Isoniazid, oral, 10mg/kg daily for 6 months
  • Maximum dose: 300 mg daily

Weight  kg	Daily isoniazid (INH) 100 mg tablet
>2–3.4 kg	¼ tablet
>3.5–6.9 kg	½ tablet
>7–9.9 kg	1 tablet
>10–14.9 kg	1½ tablets
>15–19.9 kg	2 tablets
>20–24.9 kg	2½ tablets
>25 kg	3 tablets

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Note:

For adults and adolescents initiating a DTG-containing ART regimen, isoniazid daily for 12 months is the preferred regimen. For patients who are already virally suppressed on a DTG based regimen, a weekly combination of isoniazid (900mg if weight > 30 kg) plus rifapentine (900mg if weight > 30 kg) for three months may be preferred. Do not use rifapentine-containing TPT in patients on protease inhibitor based ART, or in women on hormonal contraceptives. [See the therapeutic interchange database for details regarding the rifapentine-containing TPT regimen].

LoE:IIb³⁸ 

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Preventive therapy in case of drug-resistant TB contact:

Isoniazid mono-resistant contact: 

• Rifampicin, oral, 15 mg/kg daily for 4 months

LoE:IIb³⁸

Rifampicin mono-resistant contact:

• Isoniazid, oral, 10 mg/kg daily for 6 months (see table above)

LoE:IVb³⁹, LoE:IVb⁴⁰

Children living with HIV or malnutrition or existing neuropathy taking isoniazid:

ADD

• Pyridoxine, oral, daily for duration of prophylaxis:
  • Child < 5 years old: 12.5 mg
  • Child ≥ 5 years old: 25 mg

LoE:IVb⁴¹

REFERRAL

• Children with drug resistant TB contacts for expert advice

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4-Version 1.0_16 September 2024

Chapter 17: Respiratory Conditions_17.4 Pulmonary Tuberculosis (TB)_17.4.2 Pulmonary Tuberculosis (TB) in Children_17.4.2.1 TB Chemoprophylaxis/ Isoniazid Preventive Therapy (IPT) in Children