Tuberculosis in children

Recommended Drugs for the Treatment of Tuberculosis in Children and Adult Drug Daily dose-... 

Enarson PM, Enarson DA, Gie R. Management of tuberculosis in children in low-income countries. 

Trebucq A. Should ethambutol be recommended for routine treatment of tuberculosis in children A review of the literature. Int J Tuberc Lung Dis 1997 1(1) 12-15. 

Single dose infusions of iron dextran appear to have increased the occurrence of malaria in endemic regions. There was an increased mortality after oral or parenteral iron therapy in children with severe malnutrition (kwashiorkor), perhaps due to overwhelming infections (36). Reactivation of quiescent infections of various other types has been observed in African nomads following ferrous sulfate therapy (SEDA-4,171). Iron dextran has similarly been associated with a flaring up of latent tuberculosis in children. 

Peloquin CA, Beming SE. Tuberculosis and multi-drag resistant tuberculosis in children. Pediatr Nurs 1995 21 566-572. 

Alcais A, Fieschi C, Abel L, Casanova JL 2005 Tuberculosis in children and adults two distinct genetic diseases. J Exp Med 202 1617—1621... 

About 1.8 billion individuals, or about one-third of the world s population, are infected with Mycobacterium tuberculosis, and most of these individuals have latent infection. Although malnutrition is a major risk factor for the progression of tuberculosis, tuberculosis control programs have tended to focus upon chemoprophylaxis and chemotherapy alone, rather than upon improvement of host nutritional status. For over one hundred years, cod-liver oil, a rich source of vitamins A and D, was used as a treatment for tuberculosis. The role of nutrition and tuberculosis remains a major area of neglect, despite the promise that micronutrients have shown as therapy for other types of infections and the long record of the use of vitamins A and D for treatment of pulmonary and miliary tuberculosis in both Europe and the United States. A recent clinical trial suggests that high dose vitamin A supplementation does not alter the morbidity of tuberculosis in children [65]. Studies have not been conducted which address the use of multivitamins and minerals or vitamins A plus D as an adjunct therapy for tuberculosis. 

Bhatia and Merchant (43 ) reporting on a comparative study assessing treatment regimes in primary tuberculosis in children below the age of 5 years, found no adverse reactions in those children given ethambutol for periods ranging from 6-18 months. It will be interesting to see if this apparent lack of toxicity of the compound in young children is substantiated by further work. 

The long-term (more than several weeks) use of levofloxacin in children and adolescents has not be approved because of concerns about effects on bone and cartilage growth. However, most experts agree that the drug should be considered for children with tuberculosis caused by organisms resistant to both INH and RIF. The optimal dose is not known. 

American Thoracic Society/Centers for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000 161 1376-1395. 

Tuberculosis Initial treatment of active tuberculosis in adults and children when combined with other antituberculosis agents. 

Gastrointestinal colic (as antispas-modic) Belladonna alkaloids relax the spasm of smooth muscles of intestinal, urinary and biliary tract. They are also effective in functional and drug induced diarrhoea, to relieve urinary urgency and frequency and enuresis in children. They are also used to reduce gastric secretion in peptic ulcer patients. Also, used to reduce the excessive sweating in tuberculosis and sweating and salivation in parkinsonian patients. 

Elecampane is stated to possess expectorant, antitussive, diaphoretic, and bactericidal properties. Traditionally, it is used in the treatment of bronchial and tracheal catarrh, cough associated with pulmonary tuberculosis, and dry irritating cough in children. Alantolactone is used as an anthelmintic in the treatment of roundworm, threadworm, and whipworm infection. 

The daily dose of isoniazid is 5 mg/kg, with a maximum of 300 mg/day in adults with normal liver and kidney function. In children, 8-10 mg/kg/day is an appropriate dosage, with a maximum daily dose of 300 mg, since the metabohsm of isoniazid in children is rapid. Untoward effects of isoniazid as a single antituberculosis drug can be evaluated in preventive tuberculosis therapy, since curative regimens usually consist of multiple drugs. 

Isoniazid is the safest antituberculosis drug for use during lactation (45,46). However, as isoniazid passes into breast milk, a watch must be kept for adverse effects in the infant when a nursing mother is taking isoniazid (47). However, the serum concentrations that occur in children have no therapeutic effect and cannot be considered as a form of preventive chemotherapy in infants of mothers with active tuberculosis. 

Linna O, Uhari M. Hepatotoxicity of rifampicin and isoniazid in children treated for tuberculosis. Eur J Pediatr 1980 134(3) 227-9. 

Rollof SI. Erythema nodosum in association with sulpha-thiazole in children a clinical investigation with special reference to primary tuberculosis. Acta Tuberc Scand Suppl 1950 24 1-215. 

Septicaemia was a risk faced by mothers during childbirth and could lead to death. Ear infections were common especially in children and could lead to deafness. Pneumonia was a frequent cause of death in hospital wards. Tuberculosis was a major problem, requiring special isolation hospitals built away from populated centres. A simple cut or a wound could lead to severe infection requiring the amputation of a limb, while the threat of peritonitis lowered the success rates of surgical operations. 

Tsagaropoou-Stinga H, Mataki-Emmanouilidon R, Karida-Kavalioti S, et al. Hepatotoxic reactions in children with severe tuberculosis treated with isoniazid-rifampin. Pediatr Infect Dis 1985 4 270-273. 

Waecker NJ. Tuberculosis meningitis in children. Curr Treat Options Neurol 2002 4 249-257. 

Pyrazinamide is an antituberculosis agent. Pyrazine analog of nicotinamide may be bacteriostatic or bactericidal against Mycobacterium tuberculosis. It is indicated in an initial treatment of active tuberculosis in adults and selected children when combined with other antituberculosis agents. 

Therapy for drug-sensitive pulmonary tuberculosis consists of isoniazid (5 mg/kg, up to 300 mg/day), rifampin (10 mg/tcg/day, up to 600 mg daily), pyrazinamide (15-30 mg/kg/day or a maximum of 2 g/day), and a fourth agent, typically either ethambutol (usual adult dose cf 15 mg/kg once per day) or streptomycin (1 g daily). The streptomycin dose is reduced to 1 g twice weekly after 2 months. Pyridoxine, 15-50 mg/day, also should be included for most adults to minimize adverse reactions to isoni(K,id. Isoniazid, rifampin, pyrazinamide, and ethambutol or streptomycin are given for 2 months isoniazid and rifampin are then continued for 4 more months. Doses in children are isoniazid, 10 mg/kg/day (300 mg maximum) rifampin, 10-20 mg/kg/day (600 mg maximum) pyrazinamide, 15-30 mg/kg/day (2 g maximum). Isoniazid, rifampin, and ethambutol are considered safe during pregnancy. 

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