Anti-TB Syrup Formulations and Dosing
For children requiring liquid formulations, anti-TB syrups should contain rifampicin, isoniazid, and pyrazinamide in weight-based doses, with dosages rounded up to facilitate prescription of easily given volumes. 1
Standard Pediatric Syrup Regimen
Respiratory Tuberculosis (6-month regimen)
- Rifampicin and isoniazid syrup for 6 months, supplemented by pyrazinamide syrup for the first 2 months 1
- Ethambutol should be added in the first 2 months if drug resistance is suspected or the child meets adult criteria for a fourth drug 1
- This regimen achieves close to 100% cure rate in patients with fully sensitive organisms 1
Dosing Guidelines for Syrups
- Isoniazid: 5 mg/kg up to maximum 300 mg/day (IUATLD/WHO recommendation) 1
- Alternative dosing of 10 mg/kg up to 300 mg daily is used by some, though 5 mg/kg achieves satisfactory serum concentrations 1
- Rifampicin: 10 mg/kg (maximum 600 mg daily) 2
- Pyrazinamide: 35 mg/kg daily for patients <50 kg 2
- Dosages are rounded up to facilitate prescription of easily given volumes of syrup 1
- Dosages must be recalculated with weight gain 1
Special Situations Requiring Syrup Administration
Unconscious Patients
- Isoniazid and rifampicin can be given as syrup via nasogastric or enteral feeding tube 1
- Pyrazinamide can be given as syrup or crushed tablets via feeding tube 1
- Alternative: intravenous rifampicin (Rifadin infusion) and isoniazid (Rimifon) can be administered by once daily IV infusion 1
TB Meningitis in Children
- Minimum 12 months of rifampicin and isoniazid syrup, with initial 2 months of pyrazinamide plus a fourth drug (streptomycin or ethambutol) 1
- This extended duration is critical for CNS penetration and preventing relapse 1
Pyridoxine Supplementation with Syrup
- Not routinely necessary for children except breast-fed infants and malnourished children 1
- When needed: 25-50 mg daily 2
Administration Schedule
- Daily dosing is strongly recommended for both intensive and continuation phases 2
- Directly Observed Therapy (DOT) should be used for all TB patients, including children receiving syrups 2, 3
Common Pitfalls
- Failing to recalculate doses as children gain weight during treatment 1
- Using ethambutol in young children whose visual acuity cannot be monitored—use with caution in children under 5 years 1, 4
- Underdosing by not rounding up syrup volumes appropriately 1
- Discontinuing treatment prematurely when children appear clinically improved 1