Tuberculosis in children treated with second-line drugs under programmatic conditions in Lima, Peru

Area of Science:

• Pediatrics
• Infectious Diseases
• Public Health

Background:

• Childhood tuberculosis (TB) presents unique diagnostic and treatment challenges.
• Drug-resistant TB (DR-TB) is a growing global concern, particularly in high-burden settings.
• Second-line drugs (SLDs) are crucial for managing DR-TB but require careful characterization in pediatric populations.

Purpose of the Study:

• To characterize childhood tuberculosis (TB) cases treated with second-line drugs (SLDs) in Lima, Peru.
• To compare treatment outcomes between different age groups (<5 and 5-14 years).
• To identify indications and assess the effectiveness of SLDs in pediatric TB management.

Main Methods:

• Retrospective analysis of 82 childhood TB cases treated with SLDs between 2011 and 2015 in six districts of Lima, Peru.
• Evaluation of patient demographics, exposure history, diagnostic test results (tuberculin skin test, smear microscopy, culture), and treatment outcomes.
• Comparison of outcomes based on age groups (<5 and 5-14 years).

Main Results:

• Of 82 evaluated cases, 59% were boys, with a median age of 8 years; 32% were under 5 years old.
• Contact with a TB case was reported in 82%, and 90% were treatment-naïve. Pulmonary TB was predominant (98%).
• Only 26% had confirmed multidrug-resistant TB (MDR-TB), primarily in the 5-14 years age group. Treatment success with SLDs exceeded 83%, with no reported failures or deaths, but a high loss to follow-up rate.

Conclusions:

• The primary indication for SLDs in childhood TB was empirical treatment for suspected DR-TB, often linked to contact with known DR-TB patients.
• Bacteriological confirmation of DR-TB was limited in this cohort.
• Despite diagnostic limitations, SLD treatment demonstrated adequate success rates in childhood TB, highlighting the need for improved diagnostic confirmation and follow-up strategies.