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Category based treatment of tuberculosis in children
S K Kabra1, Rakesh Lodha, V Seth
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India. skkabra@hotmail.com
Insights
Classifying childhood tuberculosis into categories similar to adult treatment guidelines is feasible. This approach helps manage various childhood tuberculosis types effectively, improving patient outcomes.
Area of Science:
- Pediatric infectious diseases
- Public health
- Clinical management of tuberculosis
Background:
- Current childhood tuberculosis treatment regimens vary by clinical presentation.
- The World Health Organization's (WHO) category-based treatment primarily targets adult tuberculosis.
- Adapting WHO guidelines for children requires assessing the feasibility of a similar classification system.
Purpose of the Study:
- To evaluate the feasibility of classifying and managing childhood tuberculosis using a category-based system adapted from WHO adult guidelines.
- To assess the effectiveness of this classification in a real-world clinical setting.
Main Methods:
- A study was conducted at a tertiary care hospital's Pediatric Tuberculosis Clinic in North India.
- Children were classified into four categories mirroring WHO adult guidelines.
- Data on diagnosis, treatment, outcomes, and side effects were collected and analyzed.
Main Results:
- Out of 459 children, 365 (80%) completed treatment, with 82.7% cured.
- Pulmonary and lymph node tuberculosis were most common; AFB identification was low (11%).
- Hepatotoxicity occurred in 2.6% of patients, notably higher in Category IV.
Conclusions:
- A category-based classification system, similar to WHO guidelines for adults, is feasible for managing childhood tuberculosis.
- This approach facilitates effective treatment and classification of diverse pediatric tuberculosis cases.
Background:
Childhood tuberculosis is treated with multiple regimens for different clinical manifestations. World Health Organization has suggested a category-based treatment of tuberculosis that focuses on adult type of illness. To include children as DOTS beneficiaries, there is a need to assess the feasibility of classification and treatment of various types of childhood tuberculosis in different categories.
Methods:
The study was conducted in the Pediatric Tuberculosis (TB) Clinic of a tertiary care hospital in North India. All children registered in the TB clinic were classified in four categories, similar to the categorization in World Health Organization's guidelines for treatment of tuberculosis in adults. All children with freshly diagnosed serious form of tuberculosis were included in category I. Category II included patients who had treatment failure, had interrupted treatment, relapse cases and those who were suspected to have drug resistant tuberculosis. Patients with primary pulmonary complex (PPC), single lymph node tuberculosis, minimal pleural effusion and isolated skin tuberculosis were included in category III. Category IV included patients who did not improve or deteriorated despite administration of 5 drugs (as per Category II) for at least 2 months.
Results:
A total of 459 patients were started on antituberculosis drugs and were available for analysis. Pulmonary tuberculosis was the commonest followed by lymph node tuberculosis. Identification of AFB was possible only in 52 (11 percent) of the patients and was more commonly seen in lymph node tuberculosis. The mean age of the children was 93 months and sex distribution was almost equal. 323 patients were in category I, 12 in category II, 120 in category III and 4 in category IV. 365 (80 percent) children completed the treatment. Of these, 302 (82.7 percent) were cured with the primary regimen assigned to them in the beginning, 54 (14.8 percent) required extension of treatment for 3 months and 9 (2.5 percent) patients required change in the treatment regimen. Side effect in form of hepatotoxicity was observed in 12 (2.6 percent) patients and was significantly more in patients who were getting category IV treatment.
Conclusion:
It is feasible to classify and manage various types of tuberculosis in children in different categories similar to WHO guidelines for adult tuberculosis.
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