Guidelines for intensified tuberculosis case-finding and isoniazid ...

e recommended for more than six months. Similarly,there is no evidence on whether repeating a courseof IPT is beneficial for children.INH should be given at a dose of 10 mg/kg bodyweight and it is desirable that vitamin B6 be suppliedwith INH at a dose of 25 mg daily. All available datato date suggest that INH is not toxic for children, evenin those receiving ART. The following table shows asimplified dosing schedule for children (total dose 10mg of INH/kg/day).Weight range (kg)25Number of 100 mg tablets of INH to beadministered per dose (total dose 10 mg/kg/day)tablet1 tablet1 tablet2 tablets2 tablets3 tablets or one adult tabletDose given (mg)501001502002503003.3 Secondary prophylaxis and IPT with ART in children3.3.1 Secondary prophylaxisThe Guidelines Group noted that there is noevidence on the use of IPT in children livingwith HIV after successful completion of TBtreatment. However, like adults, children livingwith HIV are exposed to reinfection and recurrenceof TB. Therefore, the Group conditionallyrecommends that all children living with HIV whohave been successfully treated for TB and areliving in settings with a high TB prevalence andtransmission should receive IPT for an additionalsix months. IPT can be started immediately afterthe last dose of anti-TB therapy or at a laterdate. TB screening should be carried out for allchildren living with HIV, regardless of history of TBtreatment, during each contact of the child with ahealth-care worker (Annex 13).3.3.2 IPT with ART in childrenThe Guidelines Group concluded that there areno data regarding the efficacy of IPT for childrenstratified by degree of immunosuppression.However, it was noted that there is biologicalplausibility in extrapolating what is known for adultsand adolescents to children. Therefore, the GuidelinesGroup conditionally recommends the combined use ofIPT with ART for all children. The Guidelines Groupalso emphasized that ART should not be delayedwhile starting or completing a course of IPT.[45]3.4 The role of TST and IGRA in evaluating children for IPTThe Guidelines Group, as in the recommendationfor adults, concluded that TST is not requiredto initiate IPT in children and should not beroutinely used as part of the process to determineeligibility for IPT (Annex 9). However, the Groupnoted that TST may provide important additionalinformation in assessing a child with suspectedTB, especially if there is no positive contact history.Although a positive TST may indicate infection withmycobacteria, usually Mycobacterium tuberculosis, itis not a reliable marker of TB disease activity. Themain limitation of TST in the diagnosis of TB in HIVinfectedchildren is its variable sensitivity. Importantclinical causes of false-negative results includesevere malnutrition, severe TB disease and HIVinfection. Therefore, in settings where it is available,TST may be used for the diagnosis of active TB inchildren and may also have a role in screening forLTBI.Like TST, IGRA cannot distinguish between M.tuberculosis infection and active TB disease.24