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Recommendations Concerning the First-Line Treatment of Children with Tuberculosis

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Abstract

This document describes the recommendations of a group of scientific societies concerning the first-line therapeutic approach to paediatric tuberculosis (TB). The treatment of pulmonary TB should be based on the existence of parenchymal involvement and the risk of antibiotic resistance. The treatment of extra-pulmonary TB is based on the regimens used for severe pulmonary TB. The administration of corticosteroids is recommended only in cases of miliary TB, tuberculous meningitis and tuberculous pericarditis. Vitamin B6 may be indicated in the case of isoniazid-treated TB in breastfeeding infants, severely malnourished subjects, or patients with other diseases at high risk of vitamin deficiency. Once having started treatment, children with TB should be carefully followed up in order to evaluate compliance, the response to treatment, the need for treatment changes, and the presence of drug-related adverse events. Primary care paediatricians can support reference centres in providing family healthcare education and encouraging treatment compliance.

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Acknowledgments

This review was supported by a grant from the Italian Ministry of Health (Bando Giovani Ricercatori 2009). None of the authors have any conflict of interest to declare.

The Italian Pediatric TB Study Group also includes Samantha Bosis, Claudia Tagliabue, Laura Senatore, Beatrice Ascolese (Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy); Laura Cursi, Annalisa Grandin, Caterina Marabotto (Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy); Maurizio de Martino, Elena Chiappini, Carlotta Montagnani, Daniele Ciofi, Filippo Festini, Martina Anziati, Sabrina Becciani, Giulia Remaschi, Sara Sollai, Chiara Tersigni, Elisabetta Venturini (Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy); Alfredo Guarino, Andrea Lo Vecchio, Riccardo Scotto (Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy); Filippo Bernardi (Pediatric Emergency Unit, University of Bologna, Bologna, Italy); Elisa Bertazzoni (Pharmacology Unit, University of Verona, Verona, Italy); Francesco Blasi (Pneumology Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy); Marialuisa Bocchino, Luca Assante (Pneumology Unit, University of Naples Federico II, Naples, Italy); Elio Castagnola, Giuseppe Losurdo (Infectious Diseases Unit, IRCCS Giannina Gaslini, Genoa, Italy); Luigi Codecasa (Referral Center for Tuberculosis, Lombardy Region, Milan, Italy); Giuseppe Di Mauro (primary care paediatrician, Caserta, Italy); Marino Faccini (Prevention Department ASL Milano, Milan, Italy); Clara Gabiano, Silvia Garazzino, Daniele Le Serre, Irene Raffaldi (Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy); Gianluigi Marseglia, Amelia Mascolo (Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy); Amelia Di Comite, Mauro Stronati (Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy); Lia D’Ambrosio, Rosella Centis (World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy); Daniela Cirillo, Enrico Tortoli (Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy); Angela Pasinato (primary care paediatrician, Vicenza, Italy); Cristina Russo (Microbiology Unit, IRCCS Bambino Gesù Hospital, Rome, Italy); Franco Scaglione (Pharmacology Section, Università degli Studi di Milano, Milan, Italy); Elisabetta Scala (MOIGE Association, Rome, Italy); Paolo Tomà (Radiology Unit, IRCCS Bambino Gesù Hospital, Rome, Italy).

Scientific Societies involved in the Italian Pediatric TB Study Group: Società Italiana di Neonatologia (SIN), represented by Amelia Di Comite and Mauro Stronati; Società Italiana di Infettivologia Pediatrica (SITIP), represented by Susanna Esposito, Maurizio de Martino, Luisa Galli, Alfredo Guarino, Laura Lancella, Andrea Lo Vecchio, Nicola Principi, Samantha Bosis, Elio Castagnola, Clara Gabiano, Silvia Garazzino, Giuseppe Losurdo, Carlotta Montagnani, Martina Anziati, Beatrice Ascolese, Sabrina Becciani, Laura Cursi, Annalisa Grandin, Daniele Le Serre, Caterina Marabotto, Irene Raffaldi, Giulia Remaschi, Riccardo Scotto, Laura Senatore, Sara Sollai, Claudia Tagliabue, Chiara Tersigni and Elisabetta Venturini; Società Italiana di Pediatria (SIP), represented by Alberto Villani, Cristina Russo and Paolo Tomà; Società Italiana di Malattie Respiratorie Infantili (SIMRI), represented by Filippo Bernardi; Società Italiana di Immunologia e Allergologia Pediatrica (SIAIP) represented by Gianluigi Marseglia and Amelia Mascolo; Società Italiana di Pediatria Preventiva e Sociale (SIPPS), represented by Giuseppe Di Mauro and Elena Chiappini; Società Italiana per le Cure primarie Pediatriche (SiCUPP), represented by Angela Pasinato; Società Italiana di Malattie Respiratorie (SIMER), represented by Francesco Blasi, Marialuisa Bocchino and Luca Assante; Associazione Italiana Pneumologi Ospedalieri (AIPO), represented by Luigi Codecasa; Società Italiana di Malattie Infettive e Tropicali (SIMIT), represented by Alberto Matteelli; Associazione Microbiologi Clinici Italiani (AMCLI), represented by Enrico Tortoli; Società Italiana di Chemioterapia (SIC), represented by Elisa Bertazzoni; Società Italiana di Farmacologia (SIF), represented by Francesco Scaglione; STOP TB, represented by Daniela Cirillo, Marino Faccini, Giovanni Battista Migliori, Rosella Centis and Marina Tadolini; Società Italiana di Scienze Infermieristiche Pediatriche (SISIP), represented by Filippo Festini and Daniele Ciofi; MOIGE, represented by Elisabetta Scala.

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Authors and Affiliations

  1. Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milano, Italy

    Nicola Principi & Susanna Esposito

  2. Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy

    Luisa Galli

  3. Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy

    Laura Lancella & Alberto Villani

  4. Section of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Marina Tadolini

  5. World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy

    Giovanni Battista Migliori

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  1. Nicola Principi
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  2. Luisa Galli
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  3. Laura Lancella
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  4. Marina Tadolini
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  5. Giovanni Battista Migliori
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  6. Alberto Villani
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  7. Susanna Esposito
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For the Italian Pediatric TB Study Group

Corresponding author

Correspondence to Susanna Esposito.

Additional information

The members of the Italian Pediatric TB Study Group are listed in “Acknowledgments”.

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Principi, N., Galli, L., Lancella, L. et al. Recommendations Concerning the First-Line Treatment of Children with Tuberculosis. Pediatr Drugs 18, 13–23 (2016). https://doi.org/10.1007/s40272-015-0155-z

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