When the patient or source case is found to have INH and rifampin susceptible TB, the ethambutol can be discontinued. The daily 3 - 4 drug treatment is typically used for 2 months. At the 2-month mark, a repeat chest radiograph is obtained.
Children's chest radiographs commonly worsen before they improve, due to an appropriate immune response. If the radiograph is not improved, the families and public health workers should be queried about the child's symptoms (e.g. worsening of cough, fever and appetite), adherence and tolerance of the therapy and the accuracy of the susceptibility information.
If the child is taking and retaining essentially all of the doses, is clinically well and there is no reason to believe that the child is infected with a resistant strain, many pediatric TB clinicians will narrow the therapy to INH and rifampin twice a week by directly observed therapy (DOT) for 4 more months.
When 6 months of therapy has been completed (counting doses of directly observed therapy rather than calendar months) another chest radiograph should be obtained. The radiograph should be significantly improved, but 70% of children with active TB do not have a normal chest radiograph at the end of treatment.
If there are no concerns about the child's symptoms, adherence and radiograph, therapy can be stopped. The radiograph can be monitored over the next year to document continued improvement (and no recurrence).
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