Treatment of childhood tuberculosis

The aim of tuberculosis treatment is to cure the individual patient with antituberculosis drugs (ATT) in a short time without emergence of drug resistance. The anti tuberculosis drugs are selected in a combination to attack all the subpopulations of tubercle bacilli with first line drugs which include isoniazid, rifampicin, pyrazinamide, and ethambutol. Intermittent ATT regimens have been documented to be as effective as daily regimen. World Health Organization (WHO) has suggested a category based treatment of tuberculosis given in two phases, intensive phase and continuation phase. As per WHO, Revised National Tuberculosis Control Programme (RNTCP) recommends directly observed therapy short course strategy (DOTS) for the treatment of both adult and pediatric tuberculosis. In DOTS the patient is asked to swallow ATT under the direct observation of health personnel. Drug dosage for daily and intermittent therapy varies. To simplify the prescription, fixed drug combination (FDC) and patient-wise boxes (PWB) are available under RNTCP, free of cost. Each patient's management plan should be individualized to incorporate measures that facilitate adherence. The knowledge of drug resistant tuberculosis, HIV-related tuberculosis, and latent tuberculosis infection are the areas that need to be updated. Private practioners may play a significant role by referring the children with tuberculosis to the DOTS centers early which will not only benefit the affected family but also the society.