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Management of paediatric tuberculosis in leading UK centres: unveiling consensus and discrepancies

A Turkova1, S B Welch2, J Y Paton3

  • 1Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.

The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease
|September 6, 2014
PubMed

Insights

Clinical practice for childhood tuberculosis (TB) varies significantly across UK specialist clinics. Heterogeneity in managing latent TB infection (LTBI) and TB disease highlights the need for standardized guidelines and further research.

Area of Science:

  • Pediatric Infectious Diseases
  • Public Health
  • Clinical Practice Guidelines

Background:

  • Childhood tuberculosis (TB) management requires adherence to evolving clinical guidelines.
  • Variations in clinical practice can impact patient outcomes and treatment efficacy.
  • Specialist paediatric TB clinics play a crucial role in managing complex cases.

Purpose of the Study:

  • To evaluate current clinical practices in UK specialist paediatric TB clinics.
  • To compare observed practices against national and international TB management guidelines.
  • To identify areas of consensus and discrepancy in childhood TB care.

Main Methods:

  • A survey utilizing an electronic questionnaire was distributed to 13 specialist paediatric TB clinics in the UK.
  • The survey focused on the management of latent tuberculous infection (LTBI) and active TB disease.
  • Descriptive analysis was employed to evaluate consensus and discrepancies in reported practices.

Main Results:

  • Significant variations were observed in age limits for preventive treatment of TB contacts, interpretation of tuberculin skin tests (TSTs), and use of interferon-gamma release assays (IGRAs) for LTBI.
  • Practices differed regarding treatment duration for osteoarticular TB, monitoring for ethambutol toxicity, and pyridoxine use in children with TB disease.
  • Limited experience with multidrug-resistant TB (MDR-TB) was noted, with over half of clinics not providing preventive treatment to MDR-TB contacts.

Conclusions:

  • The study revealed considerable heterogeneity in clinical care for paediatric TB patients across specialist UK clinics.
  • Discrepancies in available paediatric TB guidelines contribute to the wide variations in management.
  • Urgent need for prospective paediatric studies to inform and standardize clinical practice, particularly concerning drug resistance.
Abstract

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