We read with interest consensus statement on childhood tuberculosis (1). This statement is not only important for private practitioner but also for those working in the Government/ Public sector. However, we would like to share our experience with childhood tuberculosis.

The Group has rightly recommended the dose of tuberculin unit for Monteux test (MT) that it should not exceed 5TU. In developing country, such as India, with high prevalence of tuberculosis, 1 TU is the recommended dose as per the WHO guidelines(2). But we have observed that pediatricians are still using 10 TU for MT and anti-tuberculous therapy are being started on the basis of positive MT. Span diagnostic, Surat one of the largest manufacturers in India is also producing 10 TU much more as compared to other strength (1 TU, 2 TU and 5 TU) as the demand of 10 TU is high (Personal communication with production manager). We have already undertaken a study to identify cutoff value for diagnosis of tubercular infection with different strength and formulation of tuberculin. Preliminary results of our study suggest false positive diagnosis of tubercular infection when MT strength is increased from 1 TU to 5 TU.

We urge the Academy to come forward and write letters to all leading manufacturers of tuberculin in India not to produce MT more than 5 TU strength. Last but not least, diagnosis of tuberculosis is not a problem in India; it is overdiagnosis and empirical use of anti-tuberculous therapy which is being the major problem.

We appreciate the concern of Dr Goyal, et al. about strength of tuberculin used in the diagnosis of childhood tuberculosis. Our group debated over this issue and arrived at consensus to suggest not more than 5 TU strength of tuberculin to be used for diagnosis of childhood tuberculosis. We also discussed whether cut-off for natural infection should be more than 10 mm. Though many of us thought that cut-off may have to be higher than 10 mm, lack of evidence made us continue with 10 mm as cut-off for the present. Further, we have already emphasised that diagnosis should not be considered on the basis of any single test. I am sure you are aware that 1TU and 2TU tuberculin is now available and it is time our members start using 1 or 2 TU tuberculin. If we stop using 10 TU, manufacturers will automatically stop producing it.

YK Amdekar,