9.2 Conventional treatment regimens

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    Table 9.1 – Conventional DS-TB regimens according to the infection site

     

    Regimens

    Duration

    Eligibility

    2(HRZE)/2(HR)

    4 months

     

     

    Children > 3 months and adolescents < 16 years with [1] Citation 1. World Health Organization. WHO operational handbook on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization; 2022.
    https://apps.who.int/iris/rest/bitstreams/1414333/retrieve         :

    Pulmonary TB (PTB)

    • microscopy smear-negative or Xpert result "negative", "trace", "very low" and "low"

    or

    • clinically diagnosed, with TB lesions confined to one lobe and no cavities on chest x-ray (CXR)

     

    Extrapulmonary TB (EPTB) non severe, i.e.:

    • pleural effusion without complications (e.g. no empyema, pneumothorax or fistula)
    • extra- or intra-thoracic lymph node TB with no airway obstruction

    2(HRZE)/4(HR)

    6 months

    PTB and EPTB (except miliary TB, TB meningitis and bone and joint TB) [2] Citation 2. World Health Organization. Guidelines for treatment of drug-susceptible tuberculosis and patient care. 2017 update.
    https://apps.who.int/iris/bitstream/handle/10665/255052/9789241550000-eng.pdf?sequence=1

    Adolescents ≥ 16 years and adults

    Children and adolescents < 16 years not eligible for the 4-month regimen or when the national protocol does not include the 4-month regimen.

    2(HRZE)/10(HR)

    12 months

    Miliary TB and TB meningitis [3] Citation 3. World Health Organization. Rapid advice: treatment of tuberculosis in children. Geneva, Switzerland 2010. WHO/HTM/TB/2010.13.
    https://iris.who.int/bitstream/handle/10665/44444/9789241500449_eng.pdf?sequence=1&isAllowed=y
    All children, adolescents and adults

    2(HRZE)/7‑10(HR)

    9-12 months

    Bone and joint TB [4] Citation 4. S. Ramachandran, I. J. Clifton, T. A. Collyns, J. P. Watson, S. B. Pearson. The treatment of spinal tuberculosis: a retrospective study. INT J TUBERC LUNG DIS 9(5):541–544 © 2005 The Union.
    https://www.ingentaconnect.com/content/iuatld/ijtld/2005/00000009/00000005/art00013?crawler=true
    All children, adolescents and adults

     

    If bacteriological testing and/or CXR are not available, children meeting the following criteria are eligible for the 4-month regimen 2(HRZE)/2(HR):

    • Signs and symptoms not requiring hospitalisation a Citation a. Symptoms requiring hospitalisation: signs of severe respiratory disease or distress, severe acute malnutrition, fever > 39 °C, severe pallor, restlessness, irritability or lethargy, etc. .
    • Extra-thoracic lymph node TB without involvement of other EP sites.

    If after one month of treatment symptoms have completely resolved, continue treatment until the end. If symptoms have not completely resolved, further investigations are needed.

    If after 4 months of treatment symptoms have not completely resolved and/or there is no weight gain, further investigation is needed. The treatment can be extended to 6 months if causes of non-response to treatment (including DR-TB, non-adherence and non-TB disease) are ruled out or unlikely.

     

    Ethambutol can be removed from the 4- and 6-month regimens in non-HIV-infected children living in areas where the prevalence of HIV and/or isoniazid resistance is low with:

    • PTB microscopy smear-negative, or
    • Extra- or intra-thoracic lymph node TB [5] Citation 5. World Health Organization. Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2nd ed. Geneva: WHO; 2014.
      https://www.who.int/publications/i/item/9789241548748             .

     

    For spinal TB, rest and back support bracing are indicated in addition to drug therapy. For patients with neurological deficit or unstable spine lesion, surgery can also be considered.

     
    Footnotes
    • (a)Symptoms requiring hospitalisation: signs of severe respiratory disease or distress, severe acute malnutrition, fever > 39 °C, severe pallor, restlessness, irritability or lethargy, etc.
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