Drug dosing for the treatment of drug-susceptible tuberculosis in children

Drugs	Dosage forms (oral)	Daily dosage (range; mg/kg)	Maximum daily dose	Adverse reactions
Ethambutol	Tablets: 100 mg 400 mg (scored) Tablets may be crushed and given with food	20 (15 to 25)	1 g	Optic neuritis (usually reversible), decreased red-green color discrimination, gastrointestinal tract disturbances, hypersensitivity
Isoniazid*	Scored tablets: 100 mg 300 mg 50 mg/mL syrup Tablets may be crushed and given with food	10 (10 to 15)	300 mg	Mild hepatic enzyme elevation, hepatitis (increased in combination with rifampin), peripheral neuropathy, hypersensitivity Given with pyridoxine to persons at risk of or with peripheral neuropathy; for moxifloxacin-rifapentine based regimen, all patients received pyridoxine^[1]
Pyrazinamide*	Scored tablets:^¶ 500 mg	35 (30 to 40)	2 g	Hepatotoxic effects, hyperuricemia, arthralgia, gastrointestinal tract upset, pruritus, rash
Rifampin (rifampicin)*	Capsules:^¶ 150 mg 300 mg	15 to 20^Δ	600 mg	Orange discoloration of secretions or urine, staining of contact lenses, vomiting, hepatitis, influenza-like reaction, thrombocytopenia, pruritus; oral contraceptives may be ineffective
Rifapentine^◊^[1]	Tablets: 150 mg Tablets may be crushed and given with food	1200 mg (weight over 40 kg, age ≥12 years)	1200 mg	Orange discoloration of secretions or urine, staining of contact lenses, headache, vomiting, hepatitis, hyperbilirubinemia, influenza-like reaction, anemia, lymphopenia, pruritus; oral contraceptives may be ineffective
Moxifloxacin^◊^[1]	Tablets: 400 mg	400 mg (weight over 40 kg, age ≥12 years)	400 mg	Tendinopathy, gastrointestinal tract disturbances, cardiac disturbances, peripheral neuropathy, rash, headache, restlessness, confusion; can prolong QTc interval, hypersensitivity reactions, theoretical effect on growing cartilage

For approach to selecting combination regimen and duration of initiation and continuation phases of treatment, refer to clinical topic. For additional dosing guidance for children weighing >40 kg or >15 years of age, including doses rounded to available pill strengths, refer to the Lexicomp drug monographs included within UpToDate.

* Combination formulations are available in some areas outside the United States containing various strengths of rifampin, isoniazid, and/or pyrazinamide; confirm local product labeling before use. Isoniazid and rifampin also are available for parenteral administration.

¶ An oral suspension may be prepared by a compounding pharmacy.

Δ Many experts recommend using a daily rifampin dose of 20 to 30 mg/kg/day for infants and toddlers and for serious forms of tuberculosis such as meningitis and disseminated disease.

◊ For details of rifapentine-moxifloxacin-based 4-month regimen, refer to separately available table in UpToDate.

Reference:

Carr W, Kurbatova E, Starks A, et al. Interim guidance: 4-month rifapentine-moxifloxacin regimen for the treatment of drug-susceptible pulmonary tuberculosis - United States, 2022. MMWR Morb Mortal Wkly Rep 2022; 7:285.

Adapted from: Tuberculosis. In: Red Book: 2021 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics 2021.

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Drug dosing for the treatment of drug-susceptible tuberculosis in children