Isoniazid-resistant tuberculosis in children: a systematic review

Courtney M Yuen1, Arielle W Tolman, Ted Cohen

  • 1Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.

Insights

Isoniazid resistance is a significant challenge in treating pediatric tuberculosis. A systematic review found a median of 8% of children with tuberculosis had isoniazid-resistant strains, indicating treatment issues.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Public Health

Background:

  • Isoniazid resistance complicates tuberculosis treatment and latent infection management in children.
  • Understanding the prevalence of isoniazid resistance is crucial for effective pediatric tuberculosis control.

Purpose of the Study:

  • To systematically review and summarize the literature on the risk of isoniazid-resistant tuberculosis in children with active tuberculosis disease.
  • To assess the scope of isoniazid resistance in pediatric tuberculosis cases globally.

Main Methods:

  • A systematic review was conducted using PubMed, Embase, and LILACS databases.
  • Searches were performed up to January 12, 2012, identifying studies on children with tuberculosis whose isolates were tested for isoniazid susceptibility.
  • 95 studies evaluating 8351 children met the inclusion criteria.

Main Results:

  • The median proportion of children with isoniazid-resistant tuberculosis strains was 8%.
  • The distribution of resistance was right-skewed, with a 75th percentile of 18%, indicating significant variability.
  • This highlights a substantial burden of isoniazid resistance in pediatric populations.

Conclusions:

  • High rates of isoniazid resistance in pediatric tuberculosis patients suggest current diagnostics and treatments may be inadequate.
  • Many children may receive ineffective empirical isoniazid-based treatment for tuberculosis or latent infection.
  • Urgent research is needed to develop effective regimens and understand the full scope of isoniazid-resistant tuberculosis in children.
Abstract

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