1. Management algorithm (Fig.1a) describes that sputum positive cases need not undergo a chest X-ray. While X-ray chest may not be necessary for diagnosis and initiation of treatment, it is vital for follow up and determination of duration of intensive phase treatment.

2. The guideline says that "There is no role for inaccurate/inconsistent diagnostics like serology (IgM, IgG, IgA antibodies against MTB antigens), various in-house or non-validated commercial PCR tests and BCG test." PCR is a very useful and promising diagnostic test for tuberculosis [2-4], though the existing commercial PCRs are non-validated. Since the PCRs for TB are likely to be validated in near future, it should have been mentioned separately rather than clubbing it with serological and BCG tests.

3. Management of childhood tuberculosis through DOTS centre is programmatically logical, but if a child has to attend DOTS centre three days a week, then his/her academic performance, self-esteem and mainstreaming is likely to be compromised. Therefore we need to find a practical solution to address this very important issue. DOTS providers are not highly skilled workers, hence one of the viable solutions could be to train school teachers assigned to ‘medical room’ in most of the schools and give them the responsibility of DOTS providers after initial registration at DOTS center. This could significantly minimize visits to DOTS centre.

4. The guidelines recommend INH prophylaxis to "All asymptomatic contacts (under 6 years of age) of a smear positive case, after ruling out active disease and irrespective of their BCG, TST or nutritional status." This appears to be an overstatement which arbitrarily puts the whole family under a cloud with consequent social stigma and even partial failure in compliance by those who really need to take it. Secondly, are we justified to give single drug chemoprophylaxis with INH which has a resistance rate of >5% in our community? What would be the overall impact on INH resistance?

5. INH chemoprophylaxis in all TST positive cases has been recommended for 6 months. What is the evidence to support this conclusion? Duration of immunosuppressant drugs is variable ranging from weeks to months. So, how can 6 months chemoprophylaxis be universal?

6. The statement "a child born to mother who was diagnosed to have TB in pregnancy should receive prophylaxis for 6 months, provided congenital TB has been ruled out" has not been supported by clinical and investigatory approach for of ruling out congenital tuberculosis. It is of paramount importance to diagnose a case of congenital TB and treat as a new case as early as possible as untreated disease is invariably fatal [5]. Therefore, diagnostic algorithm of congenital TB must be included in the guidelines both for exclusion as well as for treatment.