Managing Unavailability of the Cycloserine 125mg Capsule
In 2018, a quality-assured, 125mg capsule of cycloserine became available to countries and programs treating children with rifampicin-resistant forms of tuberculosis. This capsule is an additional formulation to the standard adult capsule which is 250mg. Although not technically a “pediatric formulation”—since the capsule is not dispersible—the existence of this 125mg capsule should allow for more precise dosing and less drug wastage in young children, since the World Health Organization recommends a weight-based dose of 15-20mg/kg/day. For a number of reasons, however, there have been challenges with the availability of the 125mg cycloserine capsule, and countries may find they are either unable to obtain the smaller capsule or are unable to use the capsule in their countries. If the 125mg capsule is not available, it is recommended that the larger 250mg capsule be used. A practical approach to using the larger capsule is detailed in the attachment, along with more information on weight-based dosing for other TB drugs.