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Drug-resistant tuberculosis: pediatric guidelines

Navaneetha Pandian Poorana Ganga Devi1, Soumya Swaminathan

  • 1National Institute for Research in Tuberculosis, Formerly The Tuberculosis Research Centre, No.1, Sathiyamoorthy Road, Chetpet, Chennai, 600 031, India, drpooranadevi@yahoo.co.in.

Current Infectious Disease Reports
|August 31, 2013
PubMed

Insights

Multidrug-resistant tuberculosis (TB) significantly impacts children globally. Despite diagnostic and treatment challenges, especially with HIV coinfection, appropriate management leads to good outcomes for pediatric drug-resistant TB.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • An estimated 650,000 global cases of multidrug-resistant tuberculosis (MDR-TB).
  • Children under 15 constitute up to 20% of TB cases in high-burden areas, indicating a substantial pediatric burden of drug-resistant TB (DR-TB).
  • Diagnosis is complicated by low bacterial burden, requiring multiple specimens and culture, though Xpert MTB/RIF offers improved sensitivity.

Purpose of the Study:

  • To summarize the current understanding of diagnosing and treating drug-resistant tuberculosis in children.
  • To highlight the specific challenges in pediatric DR-TB management, including HIV coinfection and drug formulation issues.
  • To emphasize the importance of appropriate treatment for favorable outcomes in children with DR-TB.

Main Methods:

  • Review of World Health Organization estimates on MDR-TB prevalence.
  • Discussion of diagnostic approaches, including culture and Xpert MTB/RIF assay.
  • Analysis of treatment principles, empiric regimens, and challenges in pediatric DR-TB management.

Main Results:

  • Pediatric DR-TB is a substantial global health issue.
  • Diagnosis requires advanced laboratory capabilities and can be challenging.
  • Treatment regimens are often empiric, with potential drug interactions in HIV-coinfected children.

Conclusions:

  • Children with DR-TB face unique diagnostic and treatment hurdles, including drug formulation and pharmacokinetic data limitations.
  • HIV coinfection adds complexity due to potential antiretroviral and anti-TB drug interactions.
  • Appropriate and timely treatment of pediatric DR-TB is associated with good patient outcomes.

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