Tuberculosis in children in India-II: Chemotherapy for tuberculosis

Abstract

Tubercle bacilli readily become resistant to the common drugs, and resistant bacilli are more likely to proliferate if they are present in the patient at the start of treatment. So always use more than one drug. The only possible exception is prophylaxis for an asymptomatic case with a normal X-ray. CAUTION! (1) Never give intermittent (twice or thrice weekly) treatment unless every dose can be supervised by a health worker. Daily treatment is usually mandatory. (2) When you give more than one drug, give them both at the same time, so that high blood levels coincide; do not give one drug daily and the other drug less often. THE DOSES of the commonly used drugs for daily and intermittent treatment in children and adults are: lsoniazid (H) 5 mg/kg/24 hours if he is moderately ill and 10 mg/kg/24 hours if he is severely ill. The dose for a twice weekly course is 15 mg/kg. CAUTION! Opinions on the dose of isoniazid vary. Some consider 10 mg/kg/24 hours too much for an Indian child and always give 5 mg. Rifampicin (R) 10 mg/kg/24 hours, or 10 mg/kg twice weekly. Pyrazinamide (Z) 35 mg/kg/24 hours, 75 mg/kg twice weekly or 50 mg/kg thrice weekly, is an important drug for short course treatment, so try to include it whenever it is mentioned in the regimes below. Streptomycin (S) 10-20 mg/kg/24 hours, or 40 mg/kg twice weekly, to a total of not more than 0.75 g. Streptomycin is painful, so avoid it if you can. If you give it, inject in different places each day, because repeated injections into the same site are painful. Ethambutol (E) 25 mg/kg/24 hours for 2 months, then 15 mg/kg/24 hours. Avoid ethambutol in younger children (under 12); they are unable to complain of the early symptoms of retrobulbar neuritis (blindness). Thiacetazone (T) 4 mg/kg/24 hours to a maximum Of 150 mg; unsuitable for intermittent treatment