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The MODS method for diagnosis of tuberculosis and multidrug resistant tuberculosis
Published on: August 11, 2008
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.
Background:
Isoniazid resistance is an obstacle to the treatment of tuberculosis disease and latent tuberculosis infection in children. We aim to summarize the literature describing the risk of isoniazid-resistant tuberculosis among children with tuberculosis disease.
Methods:
We did a systematic review of published reports of children with tuberculosis disease who had isolates tested for susceptibility to isoniazid. We searched PubMed, Embase and LILACS online databases up to January 12, 2012.
Results:
Our search identified 3403 citations, of which 95 studies met inclusion criteria. These studies evaluated 8351 children with tuberculosis disease for resistance to isoniazid. The median proportion of children found to have isoniazid-resistant strains was 8%; the distribution was right-skewed (25th percentile: 0% and 75th percentile: 18%).
Conclusions:
High proportions of isoniazid resistance among pediatric tuberculosis patients have been reported in many settings suggesting that diagnostics detecting only rifampin resistance are insufficient to guide appropriate treatment in this population. Many children are likely receiving substandard tuberculosis treatment with empirical isoniazid-based regimens, and treating latent tuberculosis infection with isoniazid may not be effective in large numbers of children. Work is needed urgently to identify effective regimens for the treatment of children sick with or exposed to isoniazid-resistant tuberculosis and to better understand the scope of this problem.
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