IDSA GUIDELINES Bundle (free trial)

11 • 15 mg/kg daily. Some clinicians prefer 25 mg/kg 3 times weekly. • Patients with decreased renal function may require the 15 mg/kg dose to be given only 3 times weekly to allow for drug clearance. 15–20 mg/kg - - - 25–30 mg/kg i - - - • 15 mg/kg daily. Some clinicians prefer 25 mg/kg 3 times weekly. • Patients with decreased renal function may require the 15 mg/kg dose to be given only 3 times weekly to allow for drug clearance. 15–20 mg/kg - - - 25–30 mg/kg i - - - • 15 mg/kg daily. Some clinicians prefer 25 mg/kg 3 times weekly. • Patients with decreased renal function may require the 15 mg/kg dose to be given only 3 times weekly to allow for drug clearance. 15–20 mg/kg - - - 25–30 mg/kg i - - - 8–12 g total (usually 4000 mg 2–3 times daily) ere are inadequate data to support intermittent administration. 200–300 mg/kg total (usually divided 100 mg/kg given 2–3 times daily) 500–1000 mg daily e optimal dose is not known, but clinical data suggest 15–20 mg/kg 400 mg daily ere are inadequate data to support intermittent administration. j e optimal dose is not known. Some experts use 10 mg/kg daily dosing, though lack of formulations makes such titration challenging. Aiming for serum concentrations of 3–5 μL/mL 2 h post-dose is proposed by experts as a reasonable target. f As an approach to avoiding ethambutol (EMB) ocular toxicity, some clinicians use a 3-drug regimen (INH, rifampin, and pyrazinamide) in the initial 2 months of treatment for children who are HIV- uninfected, have no prior tuberculosis treatment history, are living in an area of low prevalence for drug-resistant tuberculosis, and have no exposure to an individual from an area of high prevalence for drug-resistant tuberculosis. However, because the prevalence of and risk for drug-resistant tuberculosis can be difficult to ascertain, the American Academy of Pediatrics and most experts include EMB as part of the intensive-phase regimen for children with tuberculosis. g Clinicians experienced with using cycloserine suggest starting with 250 mg once daily and gradually increasing as tolerated. Serum concentrations oen are useful in determining the appropriate dose for a given patient. Few patients tolerate 500 mg twice daily. h Ethionamide can be given at bedtime or with a main meal in an attempt to reduce nausea. Clinicians experienced with using ethionamide suggest starting with 250 mg once daily and gradually increasing as tolerated. Serum concentrations may be useful in determining the appropriate dose for a given patient. Few patients tolerate 500 mg twice daily. i Modified from adult intermittent dose of 25 mg/kg, and accounting for larger total body water content and faster clearance of injectable drugs in most children. Dosing can be guided by serum concentrations. j RIFAQUIN trial studied a 6-month regimen. Daily isoniazid was replaced by daily moxifloxacin 400 mg for the first 2 months, followed by once-weekly doses of moxifloxacin 400 mg and RPT 1200 mg for the remaining 4 months. Two hundred twelve patients were studied (each dose of RPT was preceded by a meal of 2 hard-boiled eggs and bread). is regimen was shown to be noninferior to a standard daily administered 6-month regimen. Daily Once-Weekly Twice-Weekly Thrice-Weekly

• Cover