The document summarizes updated national guidelines for pediatric tuberculosis in India from 2012. Key points include:
1) A new diagnostic algorithm is developed for pulmonary and extra-pulmonary TB that emphasizes demonstrating bacteriological evidence and alternative specimens if sputum is unavailable.
2) Intermittent therapy remains the mainstay for treatment, but select severely ill children can receive daily therapy initially while hospitalized.
3) New case definitions are introduced for treatment failure, relapse, and treatment after default.
4) Drug dosages are rationalized into six weight bands and formulations like dispersible tablets will be explored.
5) Only two treatment regimens - one for new cases and
Knowledge and Practice of Immunization amongst the care-givers of 12-23 month...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN Surya Amal
GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN, 2013. Published by the Department of Health, Private Bag X828, Pretoria 0001, South Africa April 2013
A Study to Assess the Effectiveness of Planned Teaching Program on the Knowle...ijtsrd
Malnutrition and Tuberculosis chronic infectious disease are both problems of considerable magnitude in the most underdeveloped regions of the world. Malnutrition can leads to secondary immunodeficiency that increase the host susceptibility to infection. The aim of the study was to assess the effectiveness of planned teaching program on the knowledge and practice regarding dietary pattern among mothers of children with tuberculosis admitted in pediatric ward. Quasi experimental with two groups pre test post test design was used for 60 mothers at IPD and OPD of pediatric department and purposive sampling technique was used. Self structured questionnaire was used to assess knowledge and checklist for practice. In post test experimental group mothers have 63.3 average knowledge, 26.6 poor knowledge and 10 good knowledge while in the control group, 53.3 poor knowledge, 46.6 average knowledge and non hove good knowledge. In experimental group mean score was 17.9 1.96 while in control group mean score was 11.8 2.99. At the “p” value 0.05, the calculated t value 3.21 was compared with the tabulated value 2.01 . In post test experimental group, mothers have 53.3 good practice, 46.6 average practice and none have poor practice while in the control group, 63.33 average practice, 23.3 poor practice and 13.3 good practice. In experimental group mean score was 19.13 1.99 while in the control group, mean score was 14.06 2.85.At the “p” value 0.05, the calculated t value 3.28 was compared with the tabulated value 2.01 . These finding reveals that the planned teaching program on dietary pattern was effective. Mrs. Anchal Tiwari | Mrs. Anugrah Charan | Dr. Sarika Gupta "A Study to Assess the Effectiveness of Planned Teaching Program on the Knowledge and Practice Regarding Dietary Pattern among Mothers of Children with Tuberculosis Admitted in Pediatric Ward at KGMU Hospital, Lucknowv" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38591.pdf Paper Url: https://www.ijtsrd.com/medicine/nursing/38591/a-study-to-assess-the-effectiveness-of-planned-teaching-program-on-the-knowledge-and-practice-regarding-dietary-pattern-among-mothers-of-children-with-tuberculosis-admitted-in-pediatric-ward-at-kgmu-hospital-lucknowv/mrs-anchal-tiwari
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
Point-of-Care Ultrasound Diagnosis an Asset for IBD PatientsJason Jaramillo
An MD practicing at the Maimonides Medical Center in New York, Dr. Jason Jaramillo is part of a community private practice. Jason Jaramillo, MD, provides patient-centered ultrasound diagnostics through the handheld, bedside, Point-of-Care Ultrasound (POCUS) approach.
As reported in Gastroenterology & Endoscopy News, a 2021 University of Calgary study revealed the effectiveness of bedside POCUS in delivering meaningful, efficient care to inflammatory bowel disease (IBD) patients. The impetus was the COVID-19 pandemic and a need to restrict IBD patients’ routine endoscopy access, as well as hospitalization and visits to the emergency department.
Calgary physicians developed a centralized bedside intestinal ultrasound protocol that enabled them to accurately and objectively measure IBD progress in patients. Of the 72 patients evaluated as part of the study, more than 84 percent underwent intestinal ultrasound, sigmoidoscopy, or a combination of the two techniques, which led to detection of active inflammation and significant management changes.
Physicians referred a half dozen of these patents to colorectal surgery for complicated disease resection, and three new IBD diagnoses were made as well. With POCUS diagnosis in place, not a single IBD visited the ER across the duration of the study. In addition, 80 percent of patients avoided acute care in-hospital endoscopy. These results point to POCUS as a significant asset to gastroenterologists seeking to minimize patient time in ER and clinical settings.
Knowledge and Practice of Immunization amongst the care-givers of 12-23 month...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN Surya Amal
GUIDELINES FOR THE MANAGEMENT OF TUBERCULOSIS IN CHILDREN, 2013. Published by the Department of Health, Private Bag X828, Pretoria 0001, South Africa April 2013
A Study to Assess the Effectiveness of Planned Teaching Program on the Knowle...ijtsrd
Malnutrition and Tuberculosis chronic infectious disease are both problems of considerable magnitude in the most underdeveloped regions of the world. Malnutrition can leads to secondary immunodeficiency that increase the host susceptibility to infection. The aim of the study was to assess the effectiveness of planned teaching program on the knowledge and practice regarding dietary pattern among mothers of children with tuberculosis admitted in pediatric ward. Quasi experimental with two groups pre test post test design was used for 60 mothers at IPD and OPD of pediatric department and purposive sampling technique was used. Self structured questionnaire was used to assess knowledge and checklist for practice. In post test experimental group mothers have 63.3 average knowledge, 26.6 poor knowledge and 10 good knowledge while in the control group, 53.3 poor knowledge, 46.6 average knowledge and non hove good knowledge. In experimental group mean score was 17.9 1.96 while in control group mean score was 11.8 2.99. At the “p” value 0.05, the calculated t value 3.21 was compared with the tabulated value 2.01 . In post test experimental group, mothers have 53.3 good practice, 46.6 average practice and none have poor practice while in the control group, 63.33 average practice, 23.3 poor practice and 13.3 good practice. In experimental group mean score was 19.13 1.99 while in the control group, mean score was 14.06 2.85.At the “p” value 0.05, the calculated t value 3.28 was compared with the tabulated value 2.01 . These finding reveals that the planned teaching program on dietary pattern was effective. Mrs. Anchal Tiwari | Mrs. Anugrah Charan | Dr. Sarika Gupta "A Study to Assess the Effectiveness of Planned Teaching Program on the Knowledge and Practice Regarding Dietary Pattern among Mothers of Children with Tuberculosis Admitted in Pediatric Ward at KGMU Hospital, Lucknowv" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38591.pdf Paper Url: https://www.ijtsrd.com/medicine/nursing/38591/a-study-to-assess-the-effectiveness-of-planned-teaching-program-on-the-knowledge-and-practice-regarding-dietary-pattern-among-mothers-of-children-with-tuberculosis-admitted-in-pediatric-ward-at-kgmu-hospital-lucknowv/mrs-anchal-tiwari
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
Point-of-Care Ultrasound Diagnosis an Asset for IBD PatientsJason Jaramillo
An MD practicing at the Maimonides Medical Center in New York, Dr. Jason Jaramillo is part of a community private practice. Jason Jaramillo, MD, provides patient-centered ultrasound diagnostics through the handheld, bedside, Point-of-Care Ultrasound (POCUS) approach.
As reported in Gastroenterology & Endoscopy News, a 2021 University of Calgary study revealed the effectiveness of bedside POCUS in delivering meaningful, efficient care to inflammatory bowel disease (IBD) patients. The impetus was the COVID-19 pandemic and a need to restrict IBD patients’ routine endoscopy access, as well as hospitalization and visits to the emergency department.
Calgary physicians developed a centralized bedside intestinal ultrasound protocol that enabled them to accurately and objectively measure IBD progress in patients. Of the 72 patients evaluated as part of the study, more than 84 percent underwent intestinal ultrasound, sigmoidoscopy, or a combination of the two techniques, which led to detection of active inflammation and significant management changes.
Physicians referred a half dozen of these patents to colorectal surgery for complicated disease resection, and three new IBD diagnoses were made as well. With POCUS diagnosis in place, not a single IBD visited the ER across the duration of the study. In addition, 80 percent of patients avoided acute care in-hospital endoscopy. These results point to POCUS as a significant asset to gastroenterologists seeking to minimize patient time in ER and clinical settings.
Journal club presentation: by RxVichuZ!! ;)RxVichuZ
My 97th powerpoint... deals with the comparative study of efficacy of piperacillin-tazobactam, as compared to meropenem in the treatment of ESBL(Extended spectrum beta-lactamases) infections.
A summarized insight has been provided, using research article from JAMA.
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
SPORADIC OUTBREAK CASES OF DIPHTHERIA: A THREE YEARS’ STUDY IN A TERTIARY CAR...Earthjournal Publisher
SPORADIC OUTBREAK CASES OF DIPHTHERIA: A THREE YEARS’ STUDY IN A TERTIARY CARE CENTRE OF NORTHEAST INDIA.
Daiji Gogoi Mohan, Mayuri Gogoi,Naba Kumar Hazarika
IRO INTERNATIONAL JOURNAL OF MEDICAL AND APPLIED SCIENCES 2018, 1(1):1-5.
Immunization for INDIAN Adolescents Dr. Jyoti Agarwal Dr. Sharda Jain Dr. J...Lifecare Centre
Vaccinations are among the greatest public health achievements of the 20th century
First recorded in 1890-95
Imminization is the action of making a person immune to infection, typically by inoculation
Immunization prevents disability & death from infectious diseases
It also helps control the spread of infections within communities
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
India has the largest burden of tuberculosis. The disease is gradually extending its storm into the paediatric age group, the manifest in which is severe and tortous. So a preventive approach is always better than a curative approach
management of childhood tuberculosis in 2023.pptxPathKind Labs
diagnosis of childhood TB is a challange, but if we follow a system of screening and then appropriate diagnostic tests following contact tracing, we are likely to identify children with infection or disease and put them on appropriate treatment.
Journal club presentation: by RxVichuZ!! ;)RxVichuZ
My 97th powerpoint... deals with the comparative study of efficacy of piperacillin-tazobactam, as compared to meropenem in the treatment of ESBL(Extended spectrum beta-lactamases) infections.
A summarized insight has been provided, using research article from JAMA.
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
SPORADIC OUTBREAK CASES OF DIPHTHERIA: A THREE YEARS’ STUDY IN A TERTIARY CAR...Earthjournal Publisher
SPORADIC OUTBREAK CASES OF DIPHTHERIA: A THREE YEARS’ STUDY IN A TERTIARY CARE CENTRE OF NORTHEAST INDIA.
Daiji Gogoi Mohan, Mayuri Gogoi,Naba Kumar Hazarika
IRO INTERNATIONAL JOURNAL OF MEDICAL AND APPLIED SCIENCES 2018, 1(1):1-5.
Immunization for INDIAN Adolescents Dr. Jyoti Agarwal Dr. Sharda Jain Dr. J...Lifecare Centre
Vaccinations are among the greatest public health achievements of the 20th century
First recorded in 1890-95
Imminization is the action of making a person immune to infection, typically by inoculation
Immunization prevents disability & death from infectious diseases
It also helps control the spread of infections within communities
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
India has the largest burden of tuberculosis. The disease is gradually extending its storm into the paediatric age group, the manifest in which is severe and tortous. So a preventive approach is always better than a curative approach
management of childhood tuberculosis in 2023.pptxPathKind Labs
diagnosis of childhood TB is a challange, but if we follow a system of screening and then appropriate diagnostic tests following contact tracing, we are likely to identify children with infection or disease and put them on appropriate treatment.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
Its INC initiates to educate with services of all nurse working in clinical case management of AIDS, Malaria, Filaria, Tuberculosis,other leading infectoious diseases to prevent and control aspect of health of individual/community/society.
GFATM for nurses The Global Fund provides 30% of all international financing for HIV programs and has invested US$24.2 billion in programs to prevent and treat HIV and AIDS and US$5 billion in TB/HIV programs as of June 2022.12- make more awareness for nursinfg officer
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
Home assignment II on Spectroscopy 2024 Answers.pdf
Tb guidelines upated
1. INDIAN PEDIATRICS 301 VOLUME 50__MARCH 16, 2013
1. INTRODUCTION
P
ediatric tuberculosis (i.e., Tuberculosis
(TB) among the population aged less than 14
years) has traditionally received a lower priority
than adult TB in National TB programmes
because of its considered non-infectious, is difficult to
diagnose, cases have been thought to be few and it was
wrongly assumed that effective control of adultTB and use
of BCG by itself could prevent childhood TB. Contrary to
traditional National TB programmes, pediatric
tuberculosis (i.e., TB among the population aged less than
14 years) has always been accorded high priority by
Revised National Tuberculosis Control Programme
(RNTCP) since the inception of the programme in our
country.
In India, there are about ~400 million children who
constitute about 34% of the total population [1]. The
extent of childhood TB in India is unknown due to
diagnostic difficulties; it is estimated to be 10.2% of the
total adult incidence [2]. The maximum risk of a child
gettingTB is between 1-4 years when there is an increased
risk of progression from infection to disease. Globally,
about 1 million cases of pediatric TB are estimated to
occur every year accounting for 10-15% of allTB [3]; with
more than 100,000 estimated deaths every year, it is one of
the top 10 causes of childhood mortality. Though MDR-
TB and XDR-TB is documented among pediatric age
group, there are no estimates of overall burden, chiefly
because of diagnostic difficulties and exclusion of children
in most of the drug resistance surveys.
The proportion of pediatric TB cases registered under
RNTCP has shown an increasing trend, from 5.6% (59846
cases) in 2005 to 7% (84064 cases) in 2011 [4]. RNTCPin
association with Indian Academy of Pediatrics (IAP) has
described criteria for suspecting TB among children; has
separate algorithms for diagnosing pulmonary TB and
peripheral TB lymphadenitis and a strategy for treatment
and monitoring patients who are on treatment. In brief,TB
diagnosis is based on clinical features, smear examination
of sputum where this is available, positive family history,
tuberculin skin testing, chest radiography and
histopathological examination as appropriate.As in adults,
children withTB are classified, categorised, registered and
treated with intermittent short-course chemotherapy
(thrice-weekly therapy from treatment initiation to
completion), given under direct observation of a treatment
provider (DOT provider) and the disease status is
monitored during the course of treatment. Based on their
pre- treatment weight, children are assigned to one of pre-
treatment weight bands and are treated with good quality
anti-TB drugs through ‘‘ready-to-use’’patient wise boxes
containing the patients’ complete course of anti-TB drugs
are made available to every registered TB patient
according to programme guidelines. India was the first
country to introduce pediatric patient-wise boxes.
2. NATIONAL CONSULTATION ON DIAGNOSIS AND
MANAGEMENT OF CHILDHOOD TUBERCULOSIS [5]
In order to reconcile between Global and National
guidelines, to review the evidence base and update the
RNTCP guidelines in consensus with Indian academy of
paediatrics, a National consultation was organized in
January 2012. The consultation has come up with wider
recommendations that have been incorporated in the
programme.
2.1 Diagnosis of pediatric TB:Anew diagnostic algorithm
is developed for pulmonary TB, the commonest type of
extra pulmonary TB (Lymph nodeTB) and for other types
of extra-pulmonary TB. The diagnostic algorithms for the
diagnosis of pulmonary TB and Lymph node tuberculosis
are provided in Fig. 1. The salient recommendations are:
(a) All efforts should be made to demonstrate
Updated National Guidelines for Pediatric Tuberculosis in India, 2012†
ASHOK KUMAR, DEVESH GUPTA, SHARATH BURUGINA NAGARAJA, *VARINDER SINGH, #GR SETHI AND
‡JAGADISH PRASAD
From Central TB Division, Nirman Bhawan, *Department of Pediatrics, Lady Hardinge Medical College, #Department of
Pediatrics, Maulana Azad Medical College, and ‡Director General Health Services; Nirman Bhawan; New Delhi , India.
Correspondence to: Dr SB Nagaraja, R No 523‘C’, Central TB Division, Nirman Bhavan, New Delhi 110 008, India.
sharathb@rntcp.org
†Reprinted with permission from Journal of Indian Medical Association.
G U I D EG U I D EG U I D EG U I D EG U I D E L I N E SL I N E SL I N E SL I N E SL I N E S
2. INDIAN PEDIATRICS 302 VOLUME 50__MARCH 16, 2013
KUMAR, et al. GUIDELINES FOR PEDIATRIC TUBERCULOSIS
bacteriological evidence for the diagnosis of pediatric
TB. In cases where sputum is not available for
examination or sputum microscopy fails to
demonstrate AFB, alternative specimens (Gastric
lavage, Induced sputum, broncho-alveolar lavage)
should be collected, depending upon the feasibility,
under the supervision of a pediatrician.
(b) A positive Tuberculin skin test/Mantoux test was
1 History of unexplained weight loss or no weight gain in past 3 months; Loss of weight defined as loss of more than 5% body
weight as compared to highest weight recorded in last 3 months.
2 Radiological changes highly suggestive of TB are Hilar/paratracheal lymphadenitis with or without parenchymal lesion, miliary
TB, fibro-cavitatory pneumonia.
3 If the radiological picture is highly suggestive of TB, then proceed to do further investigations irrespective of theTST result as the
sensitivity of the test is not 100%.
4 All efforts including Gastric Lavage (GL)/ Induced sputum (IS) or Bronchoalveolar lavage (BAL) should be made to look forAcid
fast bacilli (AFB) depending upon the facilities.
All efforts including Gastric lavage (GL)/ Induced sputum (IS) or Bronchoalveolar lavage (BAL) should be made to look forAcid
fast bacilli (AFB) or for M tb rapid culture or Gene Xpert® where ever facilities are available.
FIG.1a Diagnostic algorithm for pediatric pulmonary tuberculosis
Sputum Examination
Sputum Smear positive Sputum Smear Negative /
Sputum not available for examination
• Smear positive Pulmonary TB
• Treat according to Guidelines
Child has:
1. Already received a complete course of appropriate antibiotics
2. Sick look, OR
3. Severe respiratory distress, OR
4. Any other reason for X-Ray chest OR
Yes No
X-Ray chest (XRC) &Tuberculin Skin test
(TST)
A 7-day course using antibiotic
which has no anti-TB activity e.g.
Amoxycillin, (Do not use quinolones).
XRC- Suggestive ofTB2 AND
TST positive3
Either or Both Negative
Smear positive GL/ IS/ BAL4
Follow Flowchart 2Smear negative
• Smear negative Pulmonary TB
• TreatAccording to Guidelines
• Persistent Fever and/ or Cough >2 weeks AND/ OR
• Loss of weight / No weight gain1 AND / OR
• History of contact with infectiousTB case
↓
↓
↓ ↓
↓
↓
↓
↓
↓
↓
↓
↓
No
↓
↓
↓
↓
↓
↓
↓
↓
↑
3. INDIAN PEDIATRICS 303 VOLUME 50__MARCH 16, 2013
KUMAR, et al. GUIDELINES FOR PEDIATRIC TUBERCULOSIS
defined as an induration of 10 mm or more, measured
48-72 hours after Intradermal injection with
Tuberculin 2 TU (RT 23 or equivalent). In HIV cases
the cut off is reduced to 5 mm or more of induration.
(c) There is no role for inaccurate/inconsistent
diagnostics like serology (IgM, IgG, IgA antibodies
against MTB antigens), various in-house or non-
validated commercial PCR tests and BCG test.
(d) There is no role of IGRAs in clinical practice for the
diagnosis of TB.
(e) Loss of weight – often used as a clinical marker for
the disease has been objectively defined as a loss of
more than 5% of the highest weight recorded in the
past three months.
2.2 Intermittent versus Daily regimen: The intermittent
therapy will remain the mainstay of treating pediatric
patients. However, among seriously ill admitted children
or those with severe disseminated disease/ neuro-
tuberculosis, the likelihood of vomiting or non-tolerance
of oral drugs is high in the initial phase. Such, select
group of seriously ill admitted patients can be given daily
supervised therapy during their stay in the hospital using
daily drug dosages. After discharge they will be taken on
thrice weekly DOT regimen (with suitable modification
to thrice weekly dosages). The following are the daily
doses (mg per kg of body weight per day) Rifampicin 10-
12 mg/kg (max 600 mg/day), Isoniazid 10 mg/kg (max
300 mg/day), Ethambutol 20-25 mg/kg (max 1500 mg/
day), PZA 30-35 mg/kg (max 2000 mg/day) and
Streptomycin 15 mg/kg (max 1g/day).
2.3 The following newer Case definitions for pediatric
TB patients will be incorporated in the RNTCP manuals:
(a) Failure to respond: A case of pediatric TB who fails
to have bacteriological conversion to negative status
or fails to respond clinically/or deteriorates after 12
weeks of compliant intensive phase shall be deemed
to have failed response provided alternative
diagnoses/reasons for nonresponse have been ruled
out.
FIG.1b Diagnostic algorithm for pediatric pulmonary tuberculosis.
Further investigations in Pediatric pulmonary TB suspect who
HAS PERSISTENT SYMPTOMS and does not have highly suggestive Chest skiagram
↓ ↓ ↓
XRC Normal
TST Negative
XRC – Nonspecific Shadows
TST Positive/ Negative
XRC Normal
TST positive
Repeat X-Ray Chest after a course of
Antibiotic (if not already received)
Review for an
alternate diagnosis
Review for alternate
diagnosis
Alternate Diagnosis
Established
↓ ↓ ↓
• Look for extra-pulmonary site TB,
• If no then:
– Seek Expert help
– CT Chest & other investigations
may be needed
Smear positive Smear negative
Smear positive Pulmonary TB
Treat according to Guidelines
Look for alternative diagnosis
If no alternative diagnosis found –
Treat as Smear negative PulmonaryTB
XRC – persistent non-specific shadows
TST positive/ Negative
↓
↓
NO
↓
GL/ ICS/ BAL
YES,
Give Specific therapy
↓
↓
↓
↓↓
↓ ↓
4. INDIAN PEDIATRICS 304 VOLUME 50__MARCH 16, 2013
KUMAR, et al. GUIDELINES FOR PEDIATRIC TUBERCULOSIS
(b) Relapse: A case of pediatric TB declared cured/
completed therapy in past and has (clinical or
bacteriological) evidence of recurrence.
(c) Treatment after default: A case of pediatric TB who
has taken treatment for at least 4 weeks and comes
after interruption of treatment for 2 months or more
and has active disease (clinical or bacteriological).
For programmatic purposes of reporting, all types of
retreatment cases where bacteriological evidence could
not be demonstrated but decision to treat again was taken
on clinical grounds would continue to be recorded and
reported as “Others” for surveillance purposes.
2.4 Drug dosages:
(a) To meet the pediatric fraternity concerns about under
dosing and also in view of the latest WHO guidance,
the drug dosages have been rationalized for childhood
cases. There shall be six weight bands (6-8,9-12,13-
16,17-20,21-24,and 25-30 kg) and the existing
pediatric PWBs are to be used in different
combinations to meet these expectations. In future,
three generic patient wise boxes (instead of the
existing two) will be used in combination to treat
patients in these six weight bands. It would take at-
least 2 years for supply of these new products under
RNTCP.
(b) To ensure that every child gets correct dosages,
weighing of the patient in minimal clothing (as
appropriate) using accurate weighing scales is
essential.
(c) It was also agreed that, all pediatric TB patients
should be shifted to next weight band if a child gains a
kilogram or more, above the upper limit of the
existing weight band.
2.5 Drug formulations: Since, the number of tablets is
too many to consume and younger patients have difficulty
in swallowing tablets the DOT centers will be provided
with pestle and mortars for crushing the drugs. It will be
the responsibility of the DOT provider to supervise the
process of drug consumption by the child and in case any
child vomits within half an hour of period of observation,
fresh dosages for all the drugs vomited will be provided
to the caregiver. The programme will continue to explore
the possibility of using quality fixed dose combinations
and dispersible tablets in future.
2.6 Treatment regimens: There will be only two treatment
categories – one for treating ‘new’ cases and another for
treating ‘previously treated cases.’ (Table I) Three drug
category III regime has been since withdrawn in view of
high INH resistance (>5%) in our community.
2.7 TB Meningitis: In the management of TB Meningitis,
the group recommended that streptomycin can be safely
replaced by ethambutol in intensive phase ofTBM because
of (a) current evidence favoring safety and efficacy of
ethambutol, (b) lack of any value addition in efficacy using
Streptomycin over ethambutol, and (c) need to avoid
problems of injection based treatment (lack of adequate
muscle mass in malnourished, risks of unsafe Injections,
need for a trained personnel, unpleasantness of the
treatment). While ethambutol was considered a better
optiontoreplacestreptomycininthetreatmentofnewcases
of childhood TB, streptomycin continues to be
recommendedastheadditionalfifthdrugintheretreatment
regime.
2.8 Extending intensive and continuation phase:
(a) Children who show inadequate or no response (on
smear or clinico-radiological basis) at 8 weeks of
intensive phase should be given benefit of extension of
IP for one more month.
(b) In patients with TB Meningitis, spinal TB, miliary/
disseminated TB and osteo-articular TB, the
continuation phase shall be extended by 3 months
making the total duration of treatment to a total of 9
months. A further extension may be done for 3 more
months in continuation phase (making the total
duration of treatment to 12 months) on a case to case
basis in case of delayed response and as per the
discretion of the treating physician/ pediatrician.
2.9 TB preventive therapy: The currently recommended
dose of INH for chemoprophylaxis is 10 mg/kg (instead of
currently recommended dosage of 5 mg/kg) administered
daily for 6 months. TB preventive therapy should be
provided to:
(a) All asymptomatic contacts (under 6 years of age) of a
smear positive case, after ruling out active disease and
irrespective of their BCG, TST or nutritional status.
(b) Chemoprophylaxis is also recommended for all HIV
infected children who either had a known exposure to
an infectiousTB case or areTuberculin skin test (TST)
positive (>=5 mm induration) but have no active TB
disease.
(c) All TST positive children who are receiving
immunosuppressive therapy (e.g. Children with
nephrotic syndrome, acute leukemia, etc.).
(d) Achild born to mother who was diagnosed to have TB
in pregnancy should receive prophylaxis for 6 months,
provided congenital TB has been ruled out. BCG
vaccination can be given at birth even if INH
chemoprophylaxis is planned.
5. INDIAN PEDIATRICS 305 VOLUME 50__MARCH 16, 2013
KUMAR, et al. GUIDELINES FOR PEDIATRIC TUBERCULOSIS
3. WAY FORWARD
These consensus National Guidelines on pediatric
tuberculosis was jointly developed in consultation with
Indian Academy of Pediatric and TB experts from
various premier institutions in India. Keeping the
interests of the Nation at large, it is urged that all the
clinicians, teachers, academicians, researchers or any
other person dealing with pediatric tuberculosis with in
the Government or Private or non-governmental sector
should adopt these guidelines for the diagnosis and
treatment of pediatric tuberculosis in India.
Acknowledgments: We are extremely grateful to Indian
Academy of Pediatrics (IAP) for the valuable contributions
made in revising and updating the guidelines. We also duly
acknowledge the experts opinions from various institutions like
AIIMS (New Delhi), National Institute for Research in
Tuberculosis (earlier TB Research Centre) (Chennai), National
TB Institute (Bangalore), LRS Institute of TB and Respiratory
Diseases (New Delhi), National AIDS Control Organization
(New Delhi),World Health Organisation (New Delhi),Lady
Hardinge Medical College (New Delhi), Maulana Azad
Medical College (New Delhi), Manipal Hospitals (Bangalore),
PGIMER (Chandigarh), TB Association of India (New Delhi),
Empowered Procurement Wing (EPW) MoHFW (New Delhi),
SN Medical College (Agra) and Central TB Division, MoHFW
(New Delhi) who have immensely contributed in framing the
guidelines.
Contributors: AK, VS, GS, DG: Conceived and designed; AK,
GS, VS, SBN, DG: Drafting and manuscript revision; JP: final
inputs.
Funding: None; Competing interests: None stated.
Disclaimer: This article has already been published in Journal
of Indian Medical Association (JIMA) November, 2012 issue and
kind permission has been obtained from the Hony. Editor JIMA to
publish this article in other journals.
REFERENCES
1. The Registrar General & Census Commissioner, India,
New Delhi, Ministry of Home Affairs, Government of
India; Available from: http://www.censusindia.gov.in/
TABLE I TREATMENT CATEGORIES AND REGIMENS FOR CHILDHOOD TUBERCULOSIS
Category of treatment Type of patients TB treatment regimens
Intensive Continuation
phase phase
New cases • New smear-positive pulmonary 2H3R3Z3E3* 4H3R3
Tuberculosis (PTB)
• New smear-negative PTB
• New extra-pulmonary TB
Previously treated cases • Relapse, failure to respond or treatment after default 2S3H3R3Z3E3 + 1H3R3Z3E3 5H3R3E3
• Re-treatment Others
H=Isoniazid, R= Rifampicin, Z= Pyrazinamide, E= Ethambutol, S= Streptomycin. *The number before the letters refers to the number of months
of treatment. The subscript after the letters refers to the number of doses per week.Pulmonary TB refers to disease involving lung parenchyma.
Extra Pulmonary TB refers to disease involving sites other than lung parenchyma. If both pulmonary and extra pulmonary sites are affected, it will
be considered as Pulmonary for registration purposes. Extra Pulmonary TB involving several sites should be defined by most severe site.
Smear positive: Any sample (sputum, induced sputum, gastric lavage, broncho-alveolar lavage) positive for acid fast bacilli.New Case: A patient
who has had no previous ATT or for less than 4 weeks.
Relapse: Patient declared cured/completed therapy in past and has evidence of recurrence.
Treatment after Default: A patient who has taken treatment for at least 4 weeks and comes after interruption of treatment for 2 months and has active
disease.
Failure to respond: A case of pediatric TB who fails to have bacteriological conversion to negative status or fails to respond clinically or
deteriorates after 12 weeks of compliant intensive phase shall be deemed to have failed response, provided alternative diagnoses/ reasons for non-
response have been ruled out.
Others: Cases who are smear negative or extra pulmonary but considered to have relapse, failure to respond or treatment after default or any other
case which do not fit the above definitions.
In patients with TB meningitis on Category I treatment, the four drugs used during the intensive phase can either be HRZE or HRZS. The present
evidence suggests that Ethambutol should be preferred in children.Children who show poor or no response at 8 weeks of intensive phase may be given
benefit of extension of IP for one more month. In patients with TB Meningitis, spinal TB, miliary/disseminated TB and osteo-articular TB, the
continuation phase shall be extended by 3 months making the total duration of treatment to a total of 9 months. A further extension may be done for 3
more months in continuation phase (making the total duration of treatment to 12 months) on a case to case basis in case of delayed response and as
per the discretion of the treating physician.Under Revised National Tuberculosis Program (RNTCP, all patients shall be covered under directly
observed intermittent (thrice weekly) therapy. The supervised therapy is considered as the most optimal treatment and is followed under RNTCP. It is
important to ensure completion of treatment in every case put on treatment to prevent emergence of resistance, particularly to Rifampicin. In the rare
circumstances where a patient is given daily therapy, observation and completion of therapy remains as important. It is the duty of the prescriber to
ensure appropriate and complete treatment in all cases.
6. INDIAN PEDIATRICS 306 VOLUME 50__MARCH 16, 2013
KUMAR, et al. GUIDELINES FOR PEDIATRIC TUBERCULOSIS
Census_Data_2001/India_at_Glance/broad.aspx
2. Nelson LJ, Wells CD. Global epidemiology of childhood
tuberculosis. Internat J Tubercul Lung Dis. 2004;8:636-47.
3. World Health Organization. Guidance for National
Tuberculosis Programmes on the Management of
Tuberculosis in Children, Geneva: WHO, 2006.
4. Central TB Division. Tuberculosis India 2012. Annual
Report of the Revised National Tuberculosis Control
Programme, Directorate of General Health Services,
Ministry of Health and Family Welfare, Government of
India; 2012.
5. National Guidelines on Diagnosis and Treatment of
Pediatric Tuberculosis. 2012; Available from: http://
www.tbcindia.nic.in/Paediatric guidelines_New.pdf.