Tuberculosis treatment for children: An update

Peña, María José; García, Begoña Santiago; Baquero‐Artigao, Fernando; Pérez, David Moreno; Pérez, Roi Piñeiro; Méndez‐Echevarría, Ana; Durán, D. Gómez-Pastrana; Julian, Antoni Noguera

doi:10.1016/j.anpede.2017.05.001

Cited by 13 publications

(7 citation statements)

References 21 publications

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“…The pre-dose fasting time did however correlate with C max and AUC 0-24h values in our study. A fasting state is recommended to increase INH bioavailability, but this is not always feasible in the youngest infants, in whom drug absorption may therefore be compromised [27,28]. These findings further emphasize the need to administer INH on an empty stomach.…”

Section: Discussionmentioning

confidence: 99%

Adequacy of the 10 mg/kg Daily Dose of Antituberculosis Drug Isoniazid in Infants under 6 Months of Age

Vinent

Aarnoutse²,

Colbers³

et al. 2023

Antibiotics

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In 2010, the WHO recommended an increase in the daily doses of first-line anti-tuberculosis medicines in children. We aim to characterize the pharmacokinetics of the once-daily isoniazid (INH) dose at 10 mg/kg of body weight in infants <6 months of age. We performed a multicenter pharmacokinetic study in Spain. The N-acetyltransferase 2 gene was analyzed to determine the acetylation status. Samples were analyzed using a validated UPLC-UV assay. A non-compartmental pharmacokinetic analysis was performed. Twenty-three pharmacokinetic profiles were performed in 20 infants (8 females) at a median (IQR) age of 19.0 (12.6–23.3) weeks. The acetylator statuses were homozygous fast (n = 1), heterozygous intermediate (n = 12), and homozygous slow (n = 7). INH median (IQR) Cmax and AUC0–24h values were 4.8 (3.7–6.7) mg/L and 23.5 (13.4–36.7) h*mg/L and the adult targets (>3 mg/L and 11.6–26.3 h*mg/L) were not reached in three and five cases, respectively. The age at assessment or acetylator status had no impact on Cmax values, but a larger INH AUC0–24h (p = 0.025) and trends towards a longer half-life (p = 0.055) and slower clearance (p = 0.070) were observed in homozygous slow acetylators. Treatment was well tolerated; mildly elevated alanine aminotransferase levels were observed in three cases. In our series of young infants receiving isoniazid, no major safety concerns were raised, and the target adult levels were reached in most patients.

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Section: Discussionmentioning

confidence: 99%

Adequacy of the 10 mg/kg Daily Dose of Antituberculosis Drug Isoniazid in Infants under 6 Months of Age

Vinent

Aarnoutse²,

Colbers³

et al. 2023

Antibiotics

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“…Tuberculosis (TB) screening: tuberculin skin test was considered reactive above 10 millimeters of induration measured 72 h after inoculation. In those children under 3 years previously vaccinated with BCG [Bacillus Calmette-Guérin] and tuberculin skin test reactive, IGRA test was performed [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

International Adoption of Children with Special Needs in Spain

et al. 2023

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International adoption has declined in recent years, although the adoption of children with special needs has arisen. We aim to describe our experience in the international adoption of children with special needs and to analyze the concordance between the pathologies included in pre-adoption reports and the diagnosis made upon arrival. We conducted a retrospective descriptive study including internationally adopted children with special needs evaluated at a reference Spanish unit between 2016 and 2019. Epidemiological and clinical variables were collected from medical records, and pre-adoption reports were compared to established diagnoses following their evaluation and complementary tests. Fifty-seven children were included: 36.8% females, a median age of 27 months [IQR:17–39], mostly coming from China (63.2%) and Vietnam (31.6%). The main pathologies described in the pre-adoption reports were congenital surgical malformations (40.3%), hematological (22.6%), and neurological (24.6%). The initial diagnosis that motivated the international adoption via special needs was confirmed in 79% of the children. After evaluation, 14% were diagnosed with weight and growth delay, and 17.5% with microcephaly, not previously reported. Infectious diseases were also prevalent (29.8%). According to our series, the pre-adoption reports of children with special needs appear accurate, with a low rate of new diagnoses. Pre-existing conditions were confirmed in almost 80% of cases.

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“…TSTs were performed by intradermal injection of 0.1 ml (2TU) of purified protein derivative (Tuberkulin PPD RT23 SSI, Statens Serum Institut; Copenhagen, Denmark), with results being read after 48–72 h. Following current national Spanish guidelines, the cut-offs for a positive TST result were ≥ 5 mm of induration in children assessed for clinically and/or radiologically suspected TB disease and those assessed following TB contact, and ≥ 10 mm in children undergoing new-entrant screening, irrespective of BCG vaccination status 6 , 39 .…”

Section: Methodsmentioning

confidence: 99%

Host, technical, and environmental factors affecting QuantiFERON-TB Gold In-Tube performance in children below 5 years of age

Velasco-Arnaiz¹,

Batllori

Monsonís

et al. 2022

Sci Rep

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Interferon-gamma release assays performance can be impaired by host-related, technical and environmental factors, but data in young children are limited. We performed a cross-sectional study of children < 5 years-of-age at risk of tuberculosis (TB), using QuantiFERON-TB Gold In-Tube (QFT-GIT) assays. The impact of the following was evaluated: (i) host-related [age; hematological parameters; erythrocyte sedimentation rate (ESR); C-reactive protein (CRP); and tobacco smoke exposure (TSE) based on serum cotinine concentrations], (ii) technical (pre-analytical delay) and (iii) environmental factors (annual season; monthly temperatures). Of 204 children, 35 (17.2%) were diagnosed with latent TB infection or TB disease. QFT-GIT results were indeterminate in 14 (6.9%) patients. In multivariate analysis, younger age and higher ESR were associated with lower positive control responses (beta: 0.247, p = 0.002 and − 0.204, p = 0.007, respectively), and increasing age was associated with lower rates of indeterminate QFT-GIT results [OR (95% CI) 0.948 (0.903–0.996) per month, p = 0.035]. In children with positive QFT-GIT results, average monthly temperatures correlated with antigen responses (r = 0.453, p = 0.020); also, antigen responses were lower in winter than in other seasons (p = 0.027). Serum cotinine concentrations determined in a subgroup of patients (n = 41) indicated TSE in 36 (88%), positive control responses being lower in children with TSE (p = 0.034). In children < 5 years-of-age, young age, elevated ESR, temperature, annual season and TSE can affect the performance of QFT-GIT assays.

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Tuberculosis treatment for children: An update

Cited by 13 publications

References 21 publications

Adequacy of the 10 mg/kg Daily Dose of Antituberculosis Drug Isoniazid in Infants under 6 Months of Age

Adequacy of the 10 mg/kg Daily Dose of Antituberculosis Drug Isoniazid in Infants under 6 Months of Age

International Adoption of Children with Special Needs in Spain

Host, technical, and environmental factors affecting QuantiFERON-TB Gold In-Tube performance in children below 5 years of age

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