The decision to start TB treatment in a child is an active process, which involves weighing up the clinical evidence and investigation findings, careful thought, and often a period of observation. For children with confirmed TB or for whom there is a high likelihood of TB, there is no need to hesitate about starting treatment. If the diagnostic evidence is weak and the child is older and not acutely ill, there is no need for anxiety or urgency about starting treatment.Wait and see! If, however, the child is very young and acutely ill it may be necessary to start treatment on the basis of less robust evidence.
In the past, some doctors have advocated a "treatment trial" with anti-TB drugs for purposes of diagnosis.The idea is that if the child responds to the treatment, then the diagnosis is TB.There are some problems with this approach:
a) some anti-TB drugs, such as rifampicin, kill other bacteria, so response to anti-TB drugs may be because the child has another (bacterial) infection;
b) compliance with a "treatment trial" is often poor, because of the lack of certainty surrounding the decision to treat;
c) there may be a tendency to jump too quickly to a "treatment trial" without the necessary careful and thoughtful approach to diagnosis;
d) a hasty "treatment trial" may not leave enough time to give treatment for other more common infections, such as bacterial or atypical pneumonia;
e) once TB treatment is started, it should be completed.
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