Treatment of active tuberculosis (TB) in children is usually different from treatment of TB in adults. In children younger than 4 years, TB is more likely to spread beyond the lungs (extrapulmonary TB). It is also harder to get from children a sputum sample that grows TB bacteria.¹ So the doctor may assume that a child is infected with the same type of TB bacteria as the person who most likely infected him or her.

In general, TB treatment in children usually begins with 3 medicines instead of 4 because:

• The number of bacteria usually is small.
• It may be hard to determine if a child is having vision problems, which can be caused by ethambutol.

Children with TB usually take isoniazid, rifampin, and pyrazinamide for 2 months. Treatment then continues for at least 4 more months with isoniazid and rifampin. Vitamin B6 (pyridoxine) also may be recommended during TB treatment if the child is not eating a good diet or isn't getting enough nutrients. Directly observed therapy (DOT) is usually done to make sure that the child takes all of the medicine.

Additional medicines taken for a longer time may be needed for children:

• With extrapulmonary TB.
• Who are infected with TB and human immunodeficiency virus (HIV).
• Who are infected with TB bacteria that cannot be killed by 1 or more antibiotics.

A child taking ethambutol to treat a TB infection should have his or her vision checked every month.