TB Control Programme: Medicine Regimens in Children

Uncomplicated Pulmonary TB

Complicated Pulmonary TB

Referral

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A15.0-3/A15.7-8/A16.0-2/ A16.4/A16.7-8 + (B20.0)

The employment of directly observed therapy (DOT) with short-course, fixed medicine combinations are recommended. Treatment should be given daily in both the intensive (initial) and continuation phases.

Recommended dose ranges in mg/kg
	Daily (mg/kg)	Maximum daily dose
H	10-15	300 mg
R	10-20	600 mg
Z/PZA	30-40	2 g
E/EMB	15-25	1200 mg

UNCOMPLICATED PULMONARY TB

• Includes smear negative pulmonary TB with no more than mild to moderate lymph node enlargement and/or lung field opacification, or simple pleural effusion on chest x-ray

Children <8 years of age (or <25 kg) 

Click on the image to enlarge.

* For each dose, dissolve 150 mg dispersible (1 tablet) in 3 mL of water to prepare a concentration of 50 mg/mL (150 mg/3 mL) Note: Give PZA 150 mg or 500 mg, and not both.

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Dosing recommendations for dispersible fixed dose combinations tablets:

Weight kg	2 months intensive phase given daily	4 months continuation phase given daily
	RHZ (75/50/150 mg)
		RH (75/50 mg)
4–7.9 kg	1 tablet	1 tablet
8–11.9 kg	2 tablets	2 tablets
12–15.9 kg	3 tablets	3 tablets
16–24.9 kg	4 tablets	4 tablets
≥25 kg	Adult dosages recommended

ADD

• Pyridoxine, oral, daily for 6 months if living with HIV, malnourished, or has existing neuropathy:
  • Child <5 years old: 12.5 mg
  • Child ≥5 years old: 25 mg

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Children ≥8 years and adolescents (and ≥25 kg)

Pre-treatment  body weight kg	2 months intensive phase given daily	4 months continuation phase given daily
	RHZE (150/75/400/275)	RH (150/75)	RH (300/150)
25–37.9 kg	2 tablets	2 tablets	-
38–54.9 kg	3 tablets	3 tablets
55–70.9 kg	4 tablets	-	2 tablets
>71 kg	5 tablets		2 tablets

AND

If living with HIV, malnourished or has existing neuropathy:

• Pyridoxine, oral, daily for 6 months
  • Child ≥5 years old: 25 mg
• Adjust treatment dosages to current body weight
• If calculating dosages, rather give ½ tablet more than ½ tablet less

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COMPLICATED PULMONARY TB

• Includes all other forms of pulmonary TB, such as smear positive TB, cavitating pulmonary TB, bronchopneumonic TB, large lesion pulmonary TB, and tuberculous empyema
• Refer all cases of miliary TB for exclusion of TB meningitis

Children <8 years of age (or <25 kg)

•  Intensive phase: Standard dose 4-drug therapy daily (RHZE) for 2 months

THEN

• Continuation phase: Standard dose 2-drug therapy daily for 4–7 months

Click on the image to enlarge.

* PZA: For each dose, dissolve 150 mg dispersible (1 tablet) in 3 mL of water to prepare a concentration of 50 mg/mL (150 mg/3mL).
** EMB: For each dose, crush 400 mg (1 tablet) to a fine powder and dissolve in 8 mL of water to prepare a concentration of 400mg/8mL. Discard unused solution. Note: Give PZA 150 mg or 500 mg, and not both.
*** Continuation phase may be prolonged to 7 months in slow responders and children with HIV.

AND

If living with HIV, malnourished or has existing neuropathy:

• Pyridoxine, oral, daily for 6–9 months
  • Child < 5 years old: 12.5 mg
  • Child ≥ 5 years old: 25 mg

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Children ≥ 8 years and adolescents (and > 25 kg)

Weight kg	2 months intensive phase given daily	4 months continuation phase given daily
	RHZE (150/75/400/275) mg	RH (150/75) mg	RH (300/150) mg
25–37.9 kg	2 tablets	2 tablets	-
38–54.9 kg	3 tablets	3 tablets
55–70.9 kg	4 tablets	-	2 tablets
>71 kg	5 tablets		2 tablets

AND

If living with HIV, malnourished, or has existing neuropathy:

• Pyridoxine, oral, daily for 6–9 months
  • Child ≥ 5 years old: 25 mg
• Weigh at each visit and adjust treatment dosages to body weight. If calculating dosages, rather give ½ tablet more than ½ tablet less
• Ensure that the correct dose and duration of treatment are adhered to

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REFERRAL

• Disseminated forms of TB
• All patients who cannot be managed on an ambulatory basis
• Children <12 years of age for a chest X-ray for diagnostic purposes
• Children with previously treated TB requiring re-treatment
• Children who are contacts of patients with drug resistant TB

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_17.4.2.2 TB Control Programme: Medicine Regimens in Children