The Updated National Guidelines for Pediatric Tuberculosis in India, 2012, [1] has rightly emphasized, at length, the need for becoming more aggressive in our treatment of pediatric tuberculosis (dropping out 3 drugs from all regimens i.e. HRZ). The area of chemopro-phylaxis, however, has been left untouched [except for raising the dose of INH to 10 mg/kg/day). We all know and accept that resistance to first line AKT is rapidly emerging and the article itself acknowledges that " the drug Category III has been withdrawn in view of high INH resistance [>5%] in our community". I am sure that there is a lurking fear that this figure may be much higher. In such a setting, are we justified in offering a single drug as prophylaxis? Many years ago, I had suggested that INH may not be enough for prophylaxis [2]. Today I strongly feel that this is an idea whose time has come. Serious thought needs to be given to the case of adding a second drug so that no contact is exposed to a bacillus which is resistant to the drug he is using, thus negating any benefit to him. This scenario also exposes the contact to the risk of developing tuberculous disease and it’s complications.

1. Kumar A, Gupta D, Sharath BN, Singh V, Sethi GR, Prasad J. Updated National Guidelines for Pediatric Tuberculosis in India, 2012. Indian Pediatr. 2013;50:301-6.