Caring for Children with Drug-Resistant Tuberculosis

Abstract

The management of children with drug-resistant tuberculosis (DR-TB) is challenging, and it is likely that in many places, the roll-out of molecular diagnostic testing will lead to more children being diagnosed. There is a limited evidence base to guide optimal treatment and follow-up in the pediatric population; in existing DR-TB guidelines, the care of children is often relegated to small "special populations" sections. This article seeks to address this gap by providing clinicians with practical advice and guidance. This is achieved through review of the available literature on pediatric DR-TB, including research studies and international guidelines, combined with consensus opinion from a team of experts who have extensive experience in the care of children with DR-TB in a wide variety of contexts and with varying resources. The review covers treatment initiation, regimen design and treatment duration, management of comorbid conditions, treatment monitoring, adverse events, adherence promotion, and infection control, all within a multidisciplinary environment.

Outcomes in Adolescents Undergoing Treatment for Drug-resistant Tuberculosis in Cape Town, South Africa, 2008-2013

“…While the pediatric population is often written about as a homogenous group, children along the age spectrum have different needs in terms of diagnosis and treatment that merit special attention (11). The period of adolescence defined by the WHO as between the ages of 10-19 years (12) may pose significant challenges to the management of DR-TB (13,14).…”

Multidrug-resistant and extensively drug-resistant tuberculosis: a review of current concepts and future challenges

“…40 There is no better evidence on the optimal treatment for children available. 41 A crucial issue is the adequate provision and dosing of second-line anti-TB drugs to children because most medications are not manufactured for paediatric use. 42 Children with a latent infection and under the age of 5 years are at the highest risk to progress to active TB and would …”

Commentary: A targets framework: Dismantling the invisibility trap for children with drug-resistant tuberculosis

“…44 Together they may increase practitioners' knowledge about how to evaluate children at risk and how to design and deliver effective drug regimens. To disseminate the handbook and review, we have conducted several courses, workshops, and webinars (www.sentinel-project.org).…”

“…Most children will have been infected by their closest contacts, by those with whom they share homes. 86 A consensus exists about best practices to treat DR-TB disease in children, 44 and experience is accumulating in the use of preventive therapy in child MDR-TB contacts. 69,[71][72][73]109 For an exercise to estimate targets, we will use the subset of children exposed at home to MDR-TB.…”