Do we need to revise the dose of isoniazid for the treatment of tuberculosis in children?

Extract Annually, around 1.25 million children (aged 0–14 years) are affected by tuberculosis (TB) [1]. A concern is that the case notification rate of 55% is much lower in this age group, and even worse in those aged <5 years, compared to adults, in whom it is around 80%. Despite the availability of effective anti-TB drugs, around 15% (191 000) die from TB [1]. Early diagnosis and start of treatment are the cornerstone of tackling this problem; however, children are often not able to produce sputum samples and suffer from paucibacillary disease, and among the additional diagnostic difficulties is access to radiology in resource-limited settings [2] and an urgent need for developing more specific diagnostic tests [3]. In addition, primary child healthcare and programmatic care for TB is often not integrated, complicating initiation and management of treatment [2]. To improve the quality of care for children with TB, evidence-based treatment algorithms have been developed, and included in the operational handbook of the World Health Organization (WHO) guideline to support healthcare staff in the management of TB in children [4]. In parallel, a comprehensive clinical standard has also been developed through a Delphi process to guide healthcare workers and improve care for children and adolescents with TB [5].