Table 2.

Updated TB disease treatment recommendations for children and adolescents^9,10

Recommendation	Age group	TB type and criteria or comment
4-month regimen 2HRZ(E)/2HR74*	≥3 months and ≥3 kg to <16 years	Non-severe PTB on chest X-ray Lymph node enlargement without airway compression/obstruction Non-cavitary disease confined to less than one lobe of the lungs and without a miliary pattern Uncomplicated TB pleural effusion Peripheral lymph node TB with no evidence of TB elsewhere
6-month regimen 2HRZ(E)/4HR*	All ages	PTB or EPTB that does not fit the criteria for non-severe TB Other forms of EPTB except TB meningitis and osteoarticular TB TB in all young infants <3 months or weighing <3 kg irrespective of severity
4-month regimen 2HPMfxZ/2HPMfx	≥12 years and ≥40 kg	PTB irrespective of severity
12-month regimen 2RHZE/10RH	All ages	Recommended by the WHO to treat TB meningitis, but the following caveats should be considered: The recommendation is not based on data showing greater effectiveness compared to other regimens77 Emerging data suggest that higher doses of R, in the range of 20–30 mg/kg, are needed to improve neurological outcomes78 Based on recent pharmacokinetic data, doses on the higher end of the dosing range should be considered for R, H and Z79 Some experts replace E with an agent with superior CNS penetration; Lfx 20 mg/kg once daily is a commonly used alternative Osteoarticular TB
6-month intensive regimen for TB meningitis 6RHZEth	All ages	TB meningitis Includes higher than standard dosages for RIF and INH Treatment is extended to 9 months for children and adolescents living with HIV80
Adjuvant corticosteroids (prednisone or dexamethasone)	All ages	For the following indications, prednisone 2 mg/kg/day, up to 60 mg/day (or dexamethasone 0.3 mg/kg/day, up to 9 mg/day), can be given for 4 weeks, followed by a gradual decrease in dose (taper) over 2–4 weeks before stopping: Initial 6–8 weeks of treatment for TB meningitis (strongly recommended) IRIS occurring in CNS TB (strongly recommended) IRIS associated with other forms of TB (can be considered) Endobronchial TB or intrathoracic lymphadenitis with symptomatic airway compression (should be considered) TB pericarditis (recommended by some experts)
Pyridoxine (B6)	All ages	Co-administered at a dose of 1–2 mg/kg/day, up to 25 mg/day, with INH to limit risk of neuropathy in children and adolescents with the following indications: Children living with HIV Malnourished children All infants All adolescents, especially those who are pregnant Children and adolescents receiving high-dose INH (15–20 mg/kg/day)

^*For the 2HRZ(E)/2HR and 2HRZ(E)/4HR regimens, if there has been treatment interruption for ≥14 days during the intensive phase, the regimen should be restarted. For 2HRZ(E)/2HR, if the child or adolescent missed doses on ≥30 days (cumulative) during the continuation phase, treatment should be restarted from the beginning of the intensive phase. If the child or adolescent missed doses on <30 days, complete treatment by adding all missed doses. For 2HRZ(E)/4HR, if the child or adolescent missed doses on ≥60 days (cumulative) during the continuation phase, treatment should be restarted from the beginning of the intensive phase. If the child or adolescent missed doses on <60 days, complete treatment by adding all missed doses.⁹

H, INH = isoniazid; R, RIF = rifampicin; Z = pyrazinamide; E = ethambutol; PTB = pulmonary TB; EPTB = extrapulmonary TB; Mfx = moxifloxacin; P = rifapentine; CNS = central nervous system; Lfx = levofloxacin; Eth = ethionamide; IRIS, immune reconstitution inflammatory syndrome.