Which of the following is the FIRST-LINE antituberculous drug regimen recommended for drug-sensitive pulmonary TB in children according to Indian TB guidelines?

Explanation

## Standard First-Line TB Chemotherapy in Children (India) **Key Point:** The WHO and Indian TB guidelines recommend a **2-month intensive phase (IP) followed by a 4-month continuation phase (CP)** for drug-sensitive TB in children. ### Standard Regimen: 2IP + 4CP **Intensive Phase (2 months):** - Isoniazid (H) - Rifampicin (R) - Pyrazinamide (Z) - Ethambutol (E) **Continuation Phase (4 months):** - Isoniazid (H) - Rifampicin (R) **Total duration:** 6 months ### Dosing in Children | Drug | Dose (mg/kg/day) | Remarks | | --- | --- | --- | | Isoniazid | 10–15 | Vitamin B6 supplementation recommended | | Rifampicin | 10–20 | Turns body secretions orange-red | | Pyrazinamide | 25–35 | Causes hyperuricemia; monitor uric acid | | Ethambutol | 15–25 | Risk of optic neuritis; baseline vision assessment | **High-Yield:** The 4-drug intensive phase (HRZE) kills rapidly multiplying bacilli and prevents resistance. The 2-drug continuation phase (HR) sterilizes lesions and prevents relapse. **Clinical Pearl:** Pyrazinamide is essential in the intensive phase because it penetrates caseous foci and kills semi-dormant bacilli. Omitting it prolongs treatment to 9 months. **Warning:** ~~Streptomycin is no longer part of first-line regimens~~ in India due to toxicity and the availability of better alternatives. It may be used in drug-resistant TB. **Mnemonic:** **HRZE for 2, then HR for 4** — Remember the intensive phase has all four drugs (HRZE), and continuation has only two (HR).