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[Difficulties in the treatment of pulmonary tuberculosis in children]
1Spitalul Clinic de Pneumologie, Iaşi.
Insights
Pediatric pulmonary tuberculosis management in Romania requires careful consideration of drug regimens and side effects. Treatment success rates vary, highlighting the need for individualized approaches in complex cases like HIV/AIDS comorbidities.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Public Health
Context:
- The management of pediatric pulmonary tuberculosis in Romania follows international guidelines (ERS, WHO, IUATLD).
- The Iaşi region has been involved in a pilot study since 1998.
- This study retrospectively analyzed 254 children treated between 2000 and 2005.
Purpose:
- To evaluate the treatment course, drug side effects, and outcomes of pediatric pulmonary tuberculosis in the Iaşi area.
- To assess the effectiveness of different antitubercular drug regimens.
- To identify challenges and factors influencing treatment success in children.
Summary:
- A retrospective analysis of 254 children with pulmonary tuberculosis revealed that most were new cases (98.8%).
- Treatment regimens included four-drug (47.2%), three-drug (46.9%), and individualized (5.9%) approaches, with ethambutol frequently used.
- Side effects, primarily toxic hepatitis (2.5%), occurred in 4.1% of cases. Treatment completion was 70.5%, with a cure rate of 23.6%.
- Complex cases involving HIV/AIDS and multidrug-resistant tuberculosis required extended treatment with fluoroquinolones.
Impact:
- Treatment outcomes indicate a need for optimized pediatric tuberculosis management strategies.
- Understanding drug side effects is crucial for improving patient adherence and treatment success.
- Individualized treatment plans are essential for children with comorbidities like HIV/AIDS and hepatitis B.
Unlabelled:
The management of pulmonary tuberculosis in children in Romania is done according to ERS, WHO and IUATLD recommendations, Iaşi area being included since 1998 in the pilot study.
Material And Method:
We analyzed in a descriptive and retrospective study 254 children with pulmonary tuberculosis admitted to the Iaşi Department of Pediatric Lung Diseases in the interval January 2000 - December 2005. The surveyed parameters included: treatment course, side effects of antituberculous drugs, and an assessment of the cases at the end of treatment.
Results:
This analysis revealed: 98.8% were new cases, 47.2% had received four-drug regimen for the first 2 months, 46.9% 3-drug regimen and 5.9% individualized treatment. Of the four-drug regimen 92.5% cases were treated with ethambutol. Of the 5.9% with individualized treatment 12 cases had tuberculosis and HIV/AIDS, out of which 2 with MDR tuberculosis, and 1 case with virus B hepatitis; all of them had fluoroquinolones added as well as a longer period of treatment. Side effects of antituberculous medication were encountered in 4.1%, most frequent being toxic hepatitis (2.5%). Patient evaluation at the end of treatment was done according to WHO recommendations: treatment was completed in 70.5% of cases, cured: 23.6% of the cases; relapses in 2.8%, deceased in 2.8% cases.
Conclusions:
Pulmonary tuberculosis treatment in children is difficult and must take into consideration their age and nutrition status as well as the side effects and drug combinations.
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