Introduction

Formerly Revised National TB Control Programme (RNTCP); renamed NTEP in 2020 under National Health Mission
National Strategic Plan (NSP) 2017-2025: “TB Mukt Bharat” – TB elimination by 2025 (incidence <1/1,00,000)
Strategy: Detect – Treat – Prevent – Build (DTPB)
Paediatric TB accounts for 6–7% of total notified cases (~3.42 lakh children 0–14 years estimated annually; ~1 lakh 0–14 years + 1.4 lakh 15–18 years reported)

Burden & Challenges in Children

Higher proportion of extrapulmonary TB (EPTB) and severe disseminated forms (miliary, TB meningitis) compared to adults
Paucibacillary disease → lower yield of conventional smear microscopy
Diagnostic difficulties: Non-specific symptoms, inability to expectorate sputum, overlap with malnutrition/pneumonia
High under-diagnosis & under-reporting; significant contribution to under-5 mortality
Risk factors: Household contact, severe acute malnutrition, HIV, immunosuppression

Presumptive Paediatric TB: Persistent fever/cough >2 weeks, unexplained weight loss (>5% in 3 months) or failure to gain weight, TB contact history (last 2 years)
Microbiological confirmation prioritised – Universal Drug Susceptibility Testing (U-DST)
Preferred specimens: Gastric aspirate (overnight fasting), induced sputum, sputum (older children), BAL if required
First-line test: CBNAAT (GeneXpert MTB/RIF) or Truenat for MTB detection + rifampicin resistance
Chest X-ray (frontal): Highly suggestive – hilar/mediastinal lymphadenopathy, miliary shadows, fibrocavitary lesions; non-specific findings → trial of antibiotics then re-evaluate
Supportive: TST (≥10 mm) or IGRA (not diagnostic alone)
EPTB: Site-specific (FNAC/biopsy/CSF analysis, USG/CECT/MRI as indicated)
Algorithm: Clinical suspicion → CXR → CBNAAT on appropriate sample → clinically diagnosed TB if microbiology negative but strong evidence

Bacteriologically confirmed TB: Positive smear/NAAT/culture
Clinically diagnosed TB: Strong clinical/radiological evidence + response to ATT after ruling out alternatives
Drug-resistant TB: RR/MDR/Pre-XDR/XDR based on DST

Daily weight-band paediatric Fixed-Dose Combinations (FDC) dispersible tablets (preferred)
Standard regimen: 2HRZE (Intensive phase) / 4HRE (Continuation phase) – total 6 months
Extension of continuation phase to 7–10 months in TB meningitis, osteoarticular, disseminated TB
Doses (mg/kg/day): H 7–15 (avg 10), R 10–20 (avg 15), Z 30–40 (avg 35), E 15–25 (avg 20)
Pyridoxine supplementation: 10 mg/day (<5 years), 25 mg/day (>5 years) for all INH-containing regimens
Nutritional support: Nikshay Poshan Yojana (₹500/month to all notified patients)

All-oral shorter regimens preferred; avoid injectables wherever possible
MDR/RR-TB: Bedaquiline-containing shorter oral regimen (eligible ≥5 years, ≥15 kg)
INH mono/poly-resistant: Levofloxacin-based regimen
Longer oral M/XDR-TB regimen (18–20 months) using Group A/B/C drugs based on DST
Delamanid approved for ≥6 years in selected cases
Pre-treatment evaluation & monthly monitoring (ECG, LFT, hearing)

All household contacts <5 years of pulmonary TB Index active TB ruled out (CXR + clinical evaluation)
Preferred regimens:
- 3HP (Isoniazid + Rifapentine weekly × 3 months) – >2 years
- 6H (Isoniazid daily × 6 months)
TPT for older children with positive TST/IGRA or high-risk groups (HIV, malnutrition, immunosuppression)
DR-TB contacts: Levofloxacin-based TPT (6Lfx)

Mandatory notification through Ni-kshay portal (public & private sectors)
Strong collaboration with RBSK & RKSK – active case finding, screening of school children & adolescents, referral to DEIC
Private sector engagement: Paediatric Centres of Excellence (pCoE-TB), IAP-MoHFW MoU for training
Adherence support: 99DOTS, family observed therapy, video observed treatment
Incentives: Nikshay Mitras for nutritional & social support

Monthly clinical monitoring: Weight gain, symptom resolution, adherence
End of intensive phase: Repeat CBNAAT/CXR if required
Treatment outcomes: Cured, Treatment completed, Failure, Died, Lost to follow-up
Post-treatment follow-up: 6-monthly for 2 years (detect relapse/recurrence)
Management of paradoxical reactions, adverse drug reactions & treatment interruptions