Treatment of childhood tuberculosis:
Treatment of childhood tuberculosis introduction of short term chemotherapy for childhood tuberculosis the rate of incomplete treatment and relapse has gone down considerably. Streptomycin injection’s place has been taken up by other bactericidal drugs. This has also improved the acceptance of therapy by the child. Giving 60 injec tions of streptomycin to the child was problematic job and the treatment was invariably discontinued in the middle.
There are many short course chemo therapy regimens. Depending upon the severity of disease and convenience of patient one can choose one of the following regimes.
Most acceptable treatment of childhood tuberculosis in children is :
Syr. Isonex (Ipcazide) 5 mg / kg / day for 6months.
Syr. Rifampicin (R Cin) 10 mg / kg / day for 6 months.
Syr. Pyrazinamide (PZA) 20-30 mg / kg / day in 2 divided doses for 2 months.
Tab. Ethambutol (Combutol) 15-25 mg / kg / day for 6 months.
DOTS (Direct Observation Therapy)
Patient is called on alternate day and told to take the medicine in front of the health worker. Though DOTS therapy has got advantage for Koch’s treatment in adults; it is slightly inconvenient for treatment of primary complex.
Any one of the above – mentioned regimens can be started; the parents should be informed that the orange red discoloration of urine and sweat is because of Rifampicin.
Supportive Treatment of childhood tuberculosis
Hematinic can be started along with the anti – Koch’s therapy. The child should be called every 30 days for routine check – up during which one can confirm the regular intake of medicine by the child and evaluate the general health of the child.
If cost of the therapy is beyond the capacity of the parents, the child should be referred to general hospital or some arrangements for the drugs should be made but under no circumstances the treatment should be stopped prematurely. If the parents are co-operative family screening for tuberculosis should be done to diagnose the undetected cases.
These forms are also detected in children but their events is quite less than that of primary complex in chil dren. Only salient clinical features of various extra thoracic tuberculosis are mentioned here
1. Cervical Tuberculous Lymph adenitis
Matted lymph nodes, discharging sinus may be present. Apart from other investigation lymph node biopsy can confirm the diagnosis
2. Tuberculous meningitis
May be associated with encephalitis and tuberculoma. The child may present with headache, vomiting, altered sensorium and convulsions, clinical examination may reveal + ve meningeal signs, exaggerated deep reflexes, and papilledema. Urgent hospitalization for further investigations and management is advised.
3. Abdominal tuberculosis
It may involve intestine: Ulcerative enteritis, peritoneum omentum, mesenteric lymph nodes, and ab dominal organs like kidney, liver, spleen. Child may have chronic pain in ab domen with failure to thrive. In ad vance cases ascites and symptoms and signs of intestinal obstruction may be present.
Doughy feel of abdomen is charac teristic of abdominal tuberculosis.
4. Skeletal tuberculosis
Vertebrae, knee joints, ankle joints and hip joints are usually affected. Involvement of vertebrae may give rise to deformity of spine and pressure symptoms on spinal cord, X-ray spine will show decrease in disc space. If the joint is destroyed it leads to decreased mobility of the joint.
REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM (RNTCP) FDC – FIXED DRUG COMBINATION
Anti – tubercular drugs are given on daily basis as fixed drug combination. The number of tablets per day is decided accordingly to appropriate weight band.
1. For new TB case:
a. Intensive phase: 2 HRZE- 2 months H – Isoniazide, R- Rifampicin, Z-Pyrazinamide, E-Ethambutol b. Continuation phase: 4 HRE- 4 months H- Isoniazide, R- Rifampicin, E- Ethambutol
2. For previously treated treatment of childhood tuberculosis tuberculosis:
a. Intensive phase: 2 HRZES- 2 months H- Isoniazide R- Rifampicin, Z Pyrazinamide, E- Ethambutol, S- Inj. Streptomycin 1 HRZE-Omit Inj. Strepto mycin after 2 months. b. Continuation phase 5 HRE- 5 months. H- Isoniazide, R Rifampicin, E- Ethambutol.
NOTE: THE INFORMATION PROVIDED FOR (Treatment of childhood tuberculosis) HERE IS ONLY KNOWLEDGE BASED DO NOT TREAT ANYONE AFTER READING THIS ARTICAL ,PLEASE CONSULT TO NEAREST DOCTOR FOR PROPER TREATMENT.
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