Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

Monitoring
DOT is mandatory for INH/RPT 12-week regimen. Doses must be
administered at least 72 hours apart to be counted.
The use of INH elixir is discouraged, as it commonly causes diarrhea and
cramping in children. If children have difficulty taking medications, open
capsules and crush tablets, and then hide the drugs in soft foods or liquids.
Possible foods are maple syrup, Nutella, spinach baby food, and chocolate
whipped cream. Layer the food and drug on a spoon, and teach the child to
take the contents of the spoon without chewing. 26
Children should be seen in the clinic monthly, and questions should be asked about symptoms
of toxicity as well as symptoms of active TB, adherence to therapy and results of skin testing of
family members and other contacts.
Antituberculosis drug doses should be adjusted in accordance with the
weight of the child. Monthly monitoring of body weight is therefore especially
important in pediatric cases with adjustment of doses as children gain weight.
Children taking anti-epileptic drugs and either INH or rifampin should be
monitored closely because both of these drugs can affect the metabolism and
serum levels of anti-epileptics.
Side Effects and Adverse Reactions
Families should be educated on symptoms of hepatotoxicity, for example, vomiting, loss of
appetite, abdominal pain, or jaundice, and instructed to stop the therapy and return to the clinic
if they note any symptoms which may be consistent with drug toxicity. Untoward effects of
isoniazid therapy, including severe hepatitis in otherwise healthy infants, children, and
adolescents, are rare. Monitoring of liver function is not routinely recommended for
asymptomatic children who do not have underlying liver disease and are not taking other
hepatotoxic drugs.
A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Diagnosis and Treatment of LTBI and TB Disease in Children 9.17
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