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Active pulmonary TB — RACP Paediatrics MCQ

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ModerateIDActive pulmonary TBRACP Paediatrics

A 4-year-old presents with persistent cough, fever, weight loss, and night sweats. Chest X-ray shows hilar lymphadenopathy with right middle lobe consolidation. Mantoux test is 18 mm. Early morning gastric aspirates are sent for AFB. What is the most appropriate treatment?

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Correct answer: B — Start RIPE therapy (rifampicin, isoniazid, pyrazinamide, ethambutol)

Active pulmonary TB in children is treated with standard RIPE therapy: 2 months of rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by 4 months of rifampicin and isoniazid. In children too young for visual acuity testing, ethambutol risk (optic neuritis) must be discussed. TB is notifiable and contact tracing is mandatory.

Reference: Australian Therapeutic Guidelines – 2024 – Antibiotic; RCH Melbourne – 2023 – TB CPG