Table 4.

Regimen options to treat TB infection in children and adolescents⁹

Regimen		Expected number of doses	80% of expected doses	Acceptable timeframe for TPT completion	Specific considerations or population	Management of treatment interruptions
6H (or 9H)	6 (or 9) months of daily INH 10–15 mg/kg (maximum 300 mg)	6H: 182 9H: 270	6H: 146 9H: 216	6H: 239 days* 9H: 360 days*	Standard traditional regimen but lower completion and safety profile than the shorter regimens below Suitable for children living with HIV and receiving ART, although shorter regimens preferred for adolescents† 9H is used instead of 6H in the United States	For interruptions <2 weeks, finish the remaining doses For interruptions ≥2 weeks If ≥80% of expected doses have been taken, finish the remaining doses If <80% of expected doses have been taken and the entire regimen can be completed within the acceptable timeframe (see relevant column), finish the remaining doses If <80% of expected doses have been taken and the regimen cannot be completed within the acceptable timeframe, restart TPT
3HR	3 months of daily RIF 10–20 mg/kg (maximum 600 mg) and INH 10–15 mg/kg (maximum 300 mg)	84	68	120 days*	Suitable for HIV-negative young child (<5 years) contacts using dispersible fixed-dose combination of HR 75/50 mg
4R	4 months of daily RIF 10–20 mg/kg (maximum 600 mg)	120	96	160 days*	Suitable for HIV-negative children and adolescents if suitable single RIF formulation available Liquid formulation not recommended (poor bioavailability), but capsules can be opened, and sprinkles mixed with food or water for administration to young children
3HP	3 months of weekly (12-dose) INH and RPT‡	12	Irrelevant for managing treatment interruptions	16 weeks	Preferred regimen for adolescents living with HIV if on TDF, EFV, DTG or RAL-based ART Not yet recommended for children <2 years old Large pill burden and currently available preparations make use challenging for young children§	For 1 missed dose If remembered within the next 2 days, take the missed dose immediately and continue the schedule for weekly intake as originally planned If remembered >2 days later, take the missed dose immediately and change the schedule for weekly intake to the day the missed dose was taken until regimen completion (to avoid taking 2 weekly doses ≤4 days apart) If unable to complete weekly doses in ≤16 weeks, restart TPT
1HP	One month of daily RPT 600 mg and INH 300 mg	28	23	6 weeks or 8 weeks (see last column)	Not currently recommended for children or adolescents <13 years old Can be given to adolescents ≥13 years old living with HIV if on TDF, EFV, DTG, or RAL-based ART	For interruptions <7 days If ≥80% of expected doses have been taken, finish the remaining doses If <80% of expected doses have been taken, finish the remaining doses in ≤6 weeks For interruptions ≥7 cumulative but not consecutive days, finish the remaining doses and complete the regimen in ≤8 weeks For interruptions ≥7 consecutive days, restart TPT

^*Acceptable timeframe for treatment completion is defined as the originally planned treatment duration +33% additional time in days.

^†Rifamycin-containing regimens should be used with caution in children and adolescents living with HIV and on antiretroviral therapy because of potential drug–drug interactions. They can be used with EFV-based ART regimens.^9,46

^‡INH and RPT dosing for ages 2–14 years: 10 to <16 kg, H 300 mg/P 300 mg; 16 to <24 kg, H 500 mg/P 450 mg; 24 to <31 kg, H 600 mg/P 600 mg; ≥31 kg, H 700 mg/P 750 mg. Dosing for ages ≥15 years: H 900 mg/P 900 mg.

^§May change as recommended dosage data and child-friendly preparation of RPT (150 mg) become available.

H, INH = isoniazid; ART = antiretroviral therapy; R, RIF = rifampicin; TPT = TB preventive therapy; P, RPT = rifapentine; TDF = tenofovir disoproxil fumarate; EFV = efavirenz; DTG = dolutegravir; RAL = raltegravir.