The Indian Journal of Pediatrics

, Volume 53, Issue 2, pp 179–198 | Cite as

Antituberculous therapy in children

  • Vimlesh Seth
Symposium: Pediatric Pharmacology—II


The advent of effective chemotherapeutic agents for the treatment of tuberculosis necessitates parallel emphasis in designing various short-course chemotherapy regimens in treating tuberculosis in children. Direct extrapolation from studies in adults is not appropriate because of differing pharmacokinetics and adverse drug reactions of antituberculous drugs in children. The pharmacological basis of antituberculous drugs and guidelines for using various drug regimens in relation to the varied clinical profile of tuberculosis in children have been discussed. It has been observed that the commonest type of tuberculosis in children is the pulmonary primary complex (71·4%), followed, by, progressive, primary disease (71·4%). Pleural effusion, bronchopneumonia and miliary tuberculosis are much less frequent. The 3 drug regimen does not seem to offer any advantage over the two drug regimen in the treatment of the primary pulmonary complex, as assessed by radiological clearance. Compliance is poorer in long-term and intermittent therapy as compared to short-course, continuous therapy.


Tuberculosis Rifampicin Isoniazid Pulmonary Tuberculosis Ethambutol 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Udani PM. Evaluation of tuberculin test in pediatric practice.Indian Pediatr 19: 496, 1982Google Scholar
  2. 2.
    Multicentric project of Indian Council of Medical Research to determine (i) Documentation criteria for the diagnosis of tuberculosis, (ii) Efficacy of short-course chemotherapy in pulmonary tuberculosis in children. 1984–85Google Scholar
  3. 3.
    Seth V, Mukhopadhyaya S, Bhargava S, Ray D. Documentation criteria for diagnosis and efficacy of short course chemotherapy of pulmonary tuberculosis in children. Submitted toIndian J Med Res 1985Google Scholar
  4. 4.
    Grosset J: Bacteriologic basis for short-course chemotherapy for tuberculosis.Clin Chest Med 1: 231, 1980PubMedGoogle Scholar
  5. 5.
    Tuberculosis chemotherapy trials committee. Interim report to the Medical Research Council. The treatment of pulmonary tuberculosis with isoniazid.Br Med J 2: 735, 1952Google Scholar
  6. 6.
    Van Scoy RE: Antituberculosis agents: isoniazid, rifampin, streptomycin, ethambutol.Mayo Clin Proc 52: 694, 1977PubMedGoogle Scholar
  7. 7.
    Ellard GA, Mitchinson DA, Girling DJet al: The hepatic toxicity of isoniazid among rapid and slow acetylators of the drug.Am Rev Respir Dis 118: 628, 1978PubMedGoogle Scholar
  8. 8.
    Weinstein I: Drugs used in the chemotherapy of tuberculosis and leprosy, in:The pharmacological basis of therapeutic. Goodman LS, Gilman A, (Eds); New York Macmillan Co., 1975. p 1201Google Scholar
  9. 9.
    Olson WA, Pruitt AW, Dayton PG: Plasma concentration of isoniazid in children with tuberculosis infections.Pediatrics 67: 876, 1981PubMedGoogle Scholar
  10. 10.
    Mount FW, Avastasiades AA, Schnak GA: Control study of biologically active isoniazid in serum of children with pulmonary tuberculosis.Am Rev Resp Dis 83: 173, 1961PubMedGoogle Scholar
  11. 11.
    Elmendrof DF, Cawthon WV, Muschenheim C,et al: The absorption, distribution, excretion and short-term toxicity of isonicotinic acid hydrazine (Hydrazid) in man.Am Rev Tuberc 65: 429, 1952Google Scholar
  12. 12.
    Mandell GL, Sande MA: Drugs used in chemotherapy of tuberculosis and leprosy, in:The pharmacologial basis of therapeutics. Goodman LS, Gilman A (Eds); New York Macmillan Co., 1980 p 1200Google Scholar
  13. 13.
    Gangadharam PRJ, Bhatia AL, Radhakrishna S, Selkon JB: Rate of inactivation of isoniazid in South Indian patients with pulmonary tuberculosis: Microbiological assay of isoniazid in serum following a standard intramuscular dose.Bull WHO 25: 765, 1961PubMedGoogle Scholar
  14. 14.
    Robson JM, Sullivan FM: Antituberculosis drugs.Pharmacol Rev 15: 169, 1963PubMedGoogle Scholar
  15. 15.
    Scheinhorn DJ, Angelillo VA: Antituberculosis therapy in pregnancy.West J Med 127: 195, 1977PubMedGoogle Scholar
  16. 16.
    Good JT, Iseman MD, Davidson PT, Lakshminarayan S, Sahn SA: Tuberculosis in association with pregnancy.Am J Obstet Gynecol 140: 492, 1981PubMedGoogle Scholar
  17. 17.
    Snider DE, Layde PM, Johnson MW, Lyle MA: Treatment of tuberculosis during pregnancy.Am Rev Resp Dis 122: 65, 1980PubMedGoogle Scholar
  18. 18.
    Yaffe SJ, Bedell A: Instruction for use of the reference guide in drugs in pregnancy and lactation, a reference guide to fetal and neonatal risks: ed. Briggs GG, Badendorfer TW, Freeman RG, Yaffe SJ: Williams and Wilkins, Baltimore/London, 1983Google Scholar
  19. 19.
    Timbrell JA, Mitchell JR, Snodgrass WRet al: Isoniazid hepatotoxicity the relationship between covalent binding and metabolismin vivo.J Pharmacol Exp Ther 213: 364, 1980PubMedGoogle Scholar
  20. 20.
    Tuberculosis chemotherapy centre, Madras. A controlled comparis on of twice weekly and thrice weekly regimens in the initial treatment of pulmonary tuberculosis.Bull WHO 43: 143, 1970Google Scholar
  21. 21.
    McCormack JG: Drug therapy of tuberculosis.Irish Med J 77: 88, 1984Google Scholar
  22. 22.
    Mitchell JR, Zimmerman HJ, Ishak KG,et al: Isoniazid liver injury, clinical spectrum, pathology and probable pathogenesis.Ann Intern Med 84: 181, 1976PubMedGoogle Scholar
  23. 23.
    Stein MT, Liang D: Clinical hepatotoxicity of isoniazid in children.Pediatrics 64: 499, 1979PubMedGoogle Scholar
  24. 24.
    Spyridis P, Sinaniotis C, Papadealet al: Isoniazid liver injury during chemoprophylaxis in children.Arch Dis Child 54: 65, 1979PubMedCrossRefGoogle Scholar
  25. 25.
    Beaudry PH, Brickman HF, Wise MB,et al: Liver enzyme disturbances during isoniazid chemoprophylaxis in children.Am Rev Resp Dis 110: 581, 1974.PubMedGoogle Scholar
  26. 26.
    O'Brien RJ, Long MW, Cross FS, Lyle MA, Snider DE: Hepatotoxicity from isoniazid and rifampin among children treated for tuberculosis.Pediatr 72: 491, 1983Google Scholar
  27. 27.
    Byrd RB, Horn BR, Solomon DA, Griggs GA: Toxic effects of isoniazid in tuberculosis chemoprophylaxis.JAMA 241: 1239, 1979PubMedCrossRefGoogle Scholar
  28. 28.
    Girling DJ: Adverse effects of antituberculosis drugs.Drugs 23: 56, 1982PubMedGoogle Scholar
  29. 29.
    Reed MD, Blumer JL: Clinical pharmacology of antitubercular drugs.Pediatr Clin of North America 30: 177, 1983Google Scholar
  30. 30.
    Seth Vimlesh, Seth SD, Beotra A: Hepatotoxicity in relation to the type of acetylator in children with tuberculosis. Communicated toIndian J Med Res 1985Google Scholar
  31. 31.
    Dieu MJ: Role de l'isoniazide dan l'hepatotoxicite de l'association INH-rifampicine dans tuberculose de l' enfant.J Med Lyon 53: 1323, 1972 quoted inPediatrics 72: 499, 1983PubMedGoogle Scholar
  32. 32.
    Ramchandran P: Chemotherapy of tuberculous meningitis with isoniazid plus rifampicin—interim findings in a trial in children.Indian J Tubercul 27: 54, 1980Google Scholar
  33. 33.
    Biehl JP, Vilter RW: Effects of isoniazid on pyridoxine metabolism.JAMA 156: 1549, 1954Google Scholar
  34. 34.
    Acocella G: Clinical pharmacokinetics of rifampicin.Clin Pharmacokinet 3: 108, 1978PubMedGoogle Scholar
  35. 35.
    Pamra SP: Chemotherapy of pulmonary tuberculosis—present stateIndian J Tubercul 26: 106, 1979Google Scholar
  36. 36.
    McCracken GH, Ginsburg CM, Zweighaft TCet al: Pharmacokinetics of rifampin in infants and children. Relevance to prophylaxis againstHaemophilus influenzae type b disease.Pediatrics 66: 17, 1980PubMedGoogle Scholar
  37. 37.
    Aquinas MA, Horsfall WGLet al: Adverse reactions to daily and intermittent rifampicin regimens for pulmonary tuberculosis in Hong Kong.Br Med J 1: 765, 1972PubMedGoogle Scholar
  38. 38.
    Casteels Van Daele M, Igodt AL, Corbeel Let al: Hepatotoxicity of rifampicin and isoniazid in children.J Pediatr 86: 739, 1975PubMedCrossRefGoogle Scholar
  39. 39.
    Tripathy SP: Ethambutol plus isoniazid in the treatment of tuberculosis.Bull Int Union Tubercs 49: 427, 1975Google Scholar
  40. 40.
    Seth V, Seth SD, Khosla PK: Neuro-ophthalmological examination in children on ethambutol therapy. Communicated inIndian J Med Res 1985Google Scholar
  41. 41.
    Girling DJ: The role of pyrazinamide in primary chemotherapy for pulmonary tuberculosis.Tubercle 65: 1, 1984PubMedCrossRefGoogle Scholar
  42. 42.
    Smith MHD, Marquis Jr, Tuberculosis and other microbacterial infection. In:Text book of Pediatric Infectious Diseases, Vol I Feigin RD, Cherry JD (Eds) Published by WB Saunders, 1981Google Scholar
  43. 43.
    Lorin MI, Katharine HKH, Jacob SC: Treatment of tuberculosis in children.Pediatr Clin North Amer 30: 333, 1983Google Scholar
  44. 44.
    Dingley HB: Short-course chemotherapy in children-two years follow-upIndian J Tubercul 28: 100, 1980Google Scholar
  45. 45.
    Abernathy RS, Dutt AK, Stead WW, Moers DJ: Short-course chemotherapy for tuberculosis in children.Pediatrics 72: 801, 1983PubMedGoogle Scholar
  46. 46.
    Lorber J: Tuberculous meningitis in children treated with streptomycin and PAS.Lancet i: 1104, 1954CrossRefGoogle Scholar
  47. 47.
    Kendig EL Jr: Evolution of short-course Antimicrobial treatment of tuberculosis in children.Pediatrics 75: 684, 1985PubMedGoogle Scholar
  48. 48.
    Kendig EL, Johnston WB: Short-term anti-microbial treatment of tuberculous meningitis.N Engl J Med 258: 928, 1958PubMedCrossRefGoogle Scholar
  49. 49.
    Kendig EL, Burch CD: Short-term antimicrobial therapy of tuberculous meningitis.Am Rev Resp Dis 82: 672, 1960PubMedGoogle Scholar
  50. 50.
    Smith MHD: What about short-course and intermittent chemotherapy for tuberculosis in children?Pediatr Infect Dis 1: 298, 1982PubMedCrossRefGoogle Scholar
  51. 51.
    Visudhiphan P, Chiemchanya S: Hydrocephalus in tuberculous meningitis in children, treatment with acetazolamide and repeated lumber puncture.J Pediatr 95: 657, 1979PubMedCrossRefGoogle Scholar
  52. 52.
    Steiner P, Portugaleza C: Tuberculous meningitis in children.Am Rev Resp Dis 107: 22, 1973PubMedGoogle Scholar
  53. 53.
    Place VA, Pyle MM, Huerga J: Ethambutol in tuberculous meningitisAm Rev Resp Dis 29: 783, 1969Google Scholar
  54. 54.
    Mitchison DA: Treatment of tuberculosis, the Mitchell Lecture.J Royal Coll Physoc Lon 14: 91, 19Google Scholar
  55. 55.
    Seth R: Thesis for M.D. to evaluate the hepatotoxicity and efficacy of different schedules of antitubercular drugs for the treatment of tuberculous meningitis in children. Dept. of Pediatrics, AIIMS, 1985Google Scholar
  56. 56.
    Schaefer G, Zervoudakis IA, Fuchs FF: Pregnancy and pulmonary tuberculosis.Obstet Gynecol 46: 706, 1975PubMedGoogle Scholar
  57. 57.
    Weinstein L, Murphy T: The management of tuberculosis during pregnancy.Clin Perinatol 1: 395, 1974PubMedGoogle Scholar
  58. 58.
    Beitzke H: Uber die angioborne tuberkulose infection.Ergeb Tuberk Fortschr 7: 1, 1935— quoted from Snider ES, inTubercle 65: 81, 1984Google Scholar
  59. 59.
    Speck WT: Tuberculosis during pregnancy. In:Nelson Text book of Pediatrics. Behrman RE, Vaughan VC (Eds); Published by WB Saunders 1983 p 722Google Scholar
  60. 60.
    Seth Vimlesh, Rohatagi M, Bhuyan UN, Sundaram KR, Nath Neera: Tuberculous cervical lymphadenitis in children as a relatively immune competent state.Indian J Med Res 81: 364, 1985.Google Scholar
  61. 61.
    Eichenwald HE: Tuberculosis, in:Nelson Text book of Pediatrics, Behrman RE, Vaughan VC (Eds); Published by WB Saunders. 1983 p 721Google Scholar
  62. 62.
    Waldvogel FA, Vasey H: Osteomyelitis, the past decade.N Engl J Med 303: 360, 1980PubMedCrossRefGoogle Scholar
  63. 63.
    Smith AM, Lattimer JK: Genitourinary tract involvement in child with tuberculosis.NY State J Med 73: 2325, 1973Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 1986

Authors and Affiliations

  • Vimlesh Seth
    • 1
  1. 1.Department of PediatricsAll India Institute of Medical SciencesNew Delhi

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