Children and adolescents constitute nearly 11% of the global population with tuberculosis (TB). As per the World Health Organization (WHO), annually, one million children and young adolescents below the age of 15 years develop TB and more than 225,000 of them die due to the disease. The WHO publishes guidelines on the management of TB in children and adolescents with the goal to reduce the morbidity and mortality in this age group.

Taking the recent evidence into consideration, the WHO has published updated guidelines on management of TB in children and adolescents with new recommendations for diagnosis, treatment including model of care.

The guideline strongly recommends the use of Xpert Ultra as the initial diagnostic test for TB and detection of rifampicin resistance on sputum, nasopharyngeal aspirate, gastric aspirate or stool over smear microscopy/culture and phenotypic drug susceptibility testing. Integrated treatment decision algorithms, tailored to local epidemiological settings may be used to diagnose pulmonary TB in children with presumptive pulmonary TB.

A 4-month treatment regimen (2HRZ(E)/2HR) is strongly recommended in children and adolescents between 3 months and 16 years of age with non-severe TB. “In children and adolescents with bacteriologically confirmed or clinically diagnosed TB meningitis, without suspicion or evidence of MDR/RR-TB, a 6-month intensive regimen (6HRZEto) may be used as an alternative option to the 12-month regimen (2HRZE/10HR)”.

The guideline also recommends the use of bedaquiline in children with multidrug- and rifampicin-resistant TB aged below 6 years and delamanid in children aged below 3 years with MDR/RR-TB.

Regarding models of TB care, the guideline states that decentralized TB services may be used in children and adolescents with signs and symptoms of TB and/or in those exposed to TB in areas with high TB burden. “Family-centred, integrated services in addition to standard TB services may be used in children and adolescents with signs and symptoms of TB and/or those exposed to TB”.

Source: WHO consolidated guidelines on tuberculosis. Module 5: management of tuberculosis in children and adolescents. Geneva: World Health Organization; 2022.