Tuberculosis

Patient Population:
Pediatric
Condition Major Pathogens  First Choice Therapy Alternative Therapy Comments
Latent tuberculosis infection (LTBI), positive tuberculosis skin test or interferon gamma release assay without evidence for active TB disease, without known exposure to individual with drug-resistant tuberculosis Mycobacterium tuberculosis 

Rifampin*  
17.5 mg/kg (max 600 mg/dose) enterally daily 

Drug-drug interactions should be evaluated prior to starting therapy (use Lexi-Comp drug-drug interaction checker) 

Isoniazid and Rifapentine* weekly for 12 weeks is the shortest treatment option for children 2 years and older who meet criteria; refer to linked guidelines below and consider ID consultation or discussion with local public health department   

Patient with contraindication to Rifampin (e.g. drug-drug interaction): 

Isoniazid
12.5 mg/kg (max 300 mg/dose) enterally  daily 

AND 

Pyridoxine supplementation if exclusively breastfeeding or other risk factors for peripheral neuropathy (refer to linked guidelines below)  

A short course regimen is now preferred for all eligible patients due to higher likelihood of treatment completion and lower risk for adverse effects 

Duration: 

Rifampin: 4 months 

Isoniazid: 9 months 

Refer to linked guidelines below for detailed recommendations including LTBI diagnosis and monitoring during therapy 

Initiation of LTBI therapy is not recommended during pregnancy unless at high risk for progression - discuss with ID or local public health department as needed  
Latent tuberculosis infection, defined as above, with known exposure to individual with drug-resistant tuberculosis  Mycobacterium tuberculosis, drug-resistant  Consult ID and/or local public health department    Consult ID and/or local public health department 
Active tuberculosis disease  Mycobacterium tuberculosis  Consult ID   Consult ID

References:  

Latent Tuberculosis Infection Guidance for Preventing Tuberculosis in California. California Tuberculosis Controllers Association-California Department of Public Health Joint Guideline (June 2019 revision). 

* Centers for Disease Control and Prevention. Update on Rifamycin Issues  

 

Respiratory, Head, and Neck Infections