Version July 2025
| Regimen | Dosing |
| Isoniazid* and rifapentine (3HP)¶ | Isoniazid (orally once weekly for 3 months; direct observation is preferred):
Rifapentine (orally once weekly for 3 months; direct observation is preferred):
|
| Rifampin (4R) | Rifampin 15 to 20 mg/kg PO daily for 4 months; not to exceed 600 mg/dayΔ |
| Isoniazid* and rifampin (3HR) | 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 (9H)* | Standard regimen◊:
Alternate regimen:
|
PO: by mouth; TB: tuberculosis; TBI: tuberculosis infection.
* Isoniazid tablets may be crushed and mixed with a palatable food to improve adherence. In the United States, isoniazid is available as a suspension in sorbitol (50 mg per 5 mL); however, use of this formulation may be associated with diarrhea. Peripheral neuropathy can occur among patients on 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.
¶ Pill burden is potential downside to use of 3HP in children. Rifapentine is available as 150 mg tablets with dose based on body weight; the rifapentine dose for a 25 kg child would be 450 mg (three tablets). The isoniazid dose is based on weight and age; if the 25 kg child is between ages 2 to 11, the isoniazid dose (25 mg/kg) would be 600 mg (two 300 mg tablets). Vitamin B6 (recommended for co-administration with isoniazid to children) would add a sixth tablet to each dose. Tablets may be crushed and administered in a palatable base.
Δ 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]
◊ 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.Adapted from:
