Dosing regimens for treatment of latent tuberculosis in children

Regimen	Dosing
Isoniazid* and rifapentine	Isoniazid (orally once weekly for 3 months; direct observation is preferred): For children age 12 and older, 15 mg/kg, rounded up to the nearest 50 or 100 mg; 900 mg maximum For children ages 2 to 11: 25 mg/kg; 900 mg maximum Rifapentine (orally once weekly for 3 months; direct observation is preferred): 10 to 14 kg: 300 mg 14.1 to 25 kg: 450 mg 25.1 to 32 kg: 600 mg 32.1 to 49.9 kg: 750 mg ≥50 kg: 900 mg maximum
Rifampin	Rifampin 15 to 20 mg/kg PO daily for 4 months; not to exceed 600 mg/day^¶
Isoniazid* and rifampin	Isoniazid 10 to 15 mg/kg PO daily for 3 months; not to exceed 300 mg/day Rifampin 10 to 20 mg/kg PO daily for 3 months; not to exceed 600 mg/day
Isoniazid*	Standard regimen^Δ: Isoniazid 10 to 15 mg/kg PO daily for 9 months; not to exceed 300 mg/day Alternate regimen: Isoniazid 20 to 30 mg/kg PO twice weekly^◊ for 9 months; not to exceed 900 mg/day

The efficacy and toxicity of these regimens differ and some are appropriate only for certain patient populations. For a discussion of the clinical approach to selecting a regimen for the treatment of latent TB, refer to the UpToDate topic on treatment of LTBI in children. Dosing assumes normal renal and hepatic function. For nonobese individuals, dosing for isoniazid and rifampin is based on actual body weight; optimal dosing for obese individuals has not been established.

PO: by mouth; TB: tuberculosis; LTBI: latent tuberculosis infection.
* Peripheral neuropathy can occur among patients on LTBI regimens containing isoniazid due to interference with metabolism of pyridoxine; this can be prevented with pyridoxine supplementation (25 to 50 mg daily). Administration of pyridoxine is especially important for patients with conditions that can predispose to neuropathy (including diabetes, uremia, alcoholism, malnutrition, and HIV infection) as well as in the setting of pregnancy and seizure disorders. Among children on isoniazid, pyridoxine is warranted for exclusively breastfed infants, children on meat- and milk-deficient diets, children with nutritional deficiencies, and children with symptomatic HIV infection.
¶ The American Academy of Pediatrics acknowledges that some experts use rifampin at 20 to 30 mg/kg for the daily regimen when prescribing for infants and toddlers.^[1]
Δ For children in high-income countries treated with isoniazid, a regimen of daily isoniazid for 9 months is preferred. For children in resource-limited settings treated with isoniazid, we are in agreement with the World Health Organization, which recommends 6 months of daily therapy.
◊ Twice-weekly regimens of isoniazid must be administered with directly observed therapy.

Reference:

American Academy of Pediatrics. Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021.

Adapted from:

Blumberg HM, Leonard MK Jr, Jasmer RM. Update on treatment of tuberculosis and latent tuberculosis infection. JAMA 2005; 293:2776.
Centers for Disease Control and Prevention (CDC). Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR 2011; 60:1650.
Villarino ME, Scott NA, Weis SE, et al. Treatment for preventing tuberculosis in children and adolescents: a randomized clinical trial of a 3-month, 12-dose regimen of a combination of rifapentine and isoniazid. JAMA Pediatr 2015; 169:247.

Graphic 117847 Version 6.0

خرید پکیج

Dosing regimens for treatment of latent tuberculosis in children