Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians

Area of Science:

• Pediatrics
• Infectious Diseases
• Public Health

Background:

• Tuberculosis (TB) remains a global health challenge, with an estimated 440,000 cases of multidrug-resistant TB (MDR-TB) in 2008.
• Childhood TB accounts for 10-15% of the total TB burden, yet the specific burden of MDR-TB in children is poorly understood.
• Children exposed to MDR-TB cases are at high risk of infection and disease development.

Purpose of the Study:

• To highlight the challenges and considerations for diagnosing and managing MDR-TB in pediatric populations.
• To emphasize the importance of empirical treatment and infection control in childhood MDR-TB.

Main Methods:

• Review of existing literature and WHO estimates on TB and MDR-TB.
• Discussion of treatment principles, drug susceptibility testing, and co-infection management.
• Emphasis on empirical treatment based on source case drug susceptibility when pediatric cultures are unobtainable.

Main Results:

• MDR-TB treatment in children follows adult principles, utilizing second-line drugs with careful adverse effect monitoring.
• Co-infection with HIV complicates management, necessitating early antiretroviral therapy.
• Preventive therapy for high-risk contacts lacks consensus, and effective infection control is crucial.

Conclusions:

• Managing childhood MDR-TB requires a tailored approach, considering empirical treatment and close monitoring.
• Effective infection control strategies are paramount to curb the spread of MDR-TB within communities.
• Further research and consensus guidelines are needed for optimal management of pediatric MDR-TB and its contacts.