TABLE 4 Treatment options for drug-susceptible TB (DS-TB) and DR-TB in children and adolescents Regimen Drugs Indications Contraindications DS-TB 4-month Intensive: 2HRZ or 2HRZE Continuation: 2HR Age 3 months–16 years Nonsevere PTB or peripheral lymph-node TB Infants 3 months or 3 kg Severe PTB or severe forms of EPTB Smear positive or positive for Xpert MTB/RIF or Xpert MTB/ RIF Ultra with semi-quantitative grade medium or high 4-month Intensive: 2HPMZ Continuation: 2HPM Age 12 years PTB of any disease severity Children 12 years Severe forms of EPTB 6-month Intensive: 2HRZ or 2HRZE Continuation: 4HR All ages (0–19 years) PTB or EPTB Severe EPTB forms TBM, osteoarticular TB and disseminated (miliary) TB 6-month intensive 6HRZEto No continuation phase All ages (0–19 years) Bacteriologically confirmed or clinically diagnosed DS-TBM Children living with HIV 12-months Intensive: 2HRZ or 2HRZE Continuation: 10HR All ages (0–19 years) Severe EPTB (TBM, osteoarticular TB and disseminated/ miliary TB) MDR-TB 6-month BPaLM/ BPaL No M resistance: 6 months BPaLM With M resistance: 6–9 months BPaL Aged ⩾14 years PTB or all forms of EPTB TBM, osteoarticular TB and disseminated (miliary) TB Evidence of XDR-TB Evidence of resistance or allergy to any of the component drugs Pregnancy or breastfeeding Exposure to any of the drugs composing the regimen for ⩾30 days Longer, tailored Build a regimen using first group A drugs (B-Lzd-M/Lfx), group B (Cs-Cfz) and then group C (Dlm-Eto-PAS-Z-E) All ages All forms of TB disease Duration dependent on severity of disease B: bedaquiline Pa: pretomanid L: linezolid M: moxifloxacin H isoniazid R: rifampicin Z: pyrazinamide E: ethambutol P: rifapentine TBM: tuberculous meningitis Eto: ethionamide Lzd: linezolid Lfx: levofloxacin Cs: cycloserine Cfz: clofazimine Dlm: delamanid PAS: p-aminosalicylic acid. Notes: 1) addition of E in the intensive phase of HRZ-containing regimens for PTB and EPTB is recommended in settings with prevalence of HIV or H resistance. 2) For patients at risk of neuropathy due to H (PLHIV, malnutrition, infants, adolescents, high-dose H), pyridoxine (B 6 )supplementation should be considered. 3) Adjuvant treatment is indicated for the treatment of TBM. 4) For the 6-month intensive treatment for TBM, higher dosages of R (22.5–30 mg·kg −1 ),H (15–20 mg·kg−1) and Z (35–45 mg·kg−1) are used compared with the doses for PTB and other forms of disease. 5) Corticosteroids should be given at the time of initial diagnosis of TBM and are also indicated in the treatment of TB pericarditis. Corticosteroids are sometimes used in the management of other complicated forms of TB (e.g. complications of airway obstruction by TB lymph nodes), but the evidence base for other indications is poor. Prednisone is given orally (2 mg·kg−1 once daily, maximum dosage of 60 mg·day−1) for 4 weeks. The dose should then be reduced gradually over 2–4 weeks before stopping. https://doi.org/10.1183/2312508X.10025322 223 CHILDREN AND ADOLESCENTS |E. LÓPEZ-VARELA ET AL.