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Multi-Drug Resistant and Extensively-Drug Resistant Tuberculosis
Ira Shah1, Vishrutha Poojari2, Himali Meshram2
1Pediatric TB and DR-TB Clinic, Department of Pediatric Infectious Diseases, B J Wadia Hospital for Children, Mumbai, 400012, India. irashah@pediatriconcall.com.
Indian Journal of Pediatrics
|February 28, 2020
Summary
Drug-resistant tuberculosis (DR TB) treatment is challenging, especially in children. New drugs like bedaquiline and delaminid offer hope, but pediatric treatment outcomes require further study.
Area of Science:
- Infectious Diseases
- Public Health
- Pharmacology
Background:
- India faces a high burden of tuberculosis (TB), including multi-drug resistant (MDR-TB) and extensively drug-resistant (XDR-TB) strains.
- Drug-resistant TB poses a significant global health challenge, with difficult treatment regimens involving second-line drugs, high costs, side effects, and long durations.
- Individualized treatment for MDR-TB is becoming standard, considering factors like oral drug preference, drug susceptibility testing (DST), population resistance, treatment history, tolerability, and drug interactions.
Purpose of the Study:
- To review the current landscape of pediatric drug-resistant TB treatment, focusing on newer anti-TB drugs.
- To highlight the limited data on treatment outcomes for pediatric MDR/XDR-TB using novel regimens.
- To emphasize the potential for improved survival in children treated with individualized regimens.
Main Methods:
- Literature review of current guidelines and research on drug-resistant TB treatment in pediatric populations.
- Analysis of the recommended usage of newer anti-TB drugs, bedaquiline (BDQ) and delaminid (DLM), in children.
- Examination of factors influencing individualized treatment regimens for MDR-TB.
Main Results:
- Bedaquilline (BDQ) is recommended by the World Health Organization (WHO) for patients over 15 years (>15 kg), while India's Revised National Tuberculosis Control Programme (RNTCP) restricts its use to patients over 18 years.
- Delaminid (DLM) is approved under RNTCP for children aged 6 years and above.
- Data on treatment outcomes for pediatric MDR/XDR-TB using newer anti-TB drugs and regimens are currently lacking.
Conclusions:
- There is a critical need for more research on the efficacy and safety of newer anti-TB drugs in pediatric drug-resistant TB.
- Individualized treatment regimens have shown promise in improving survival rates for children with drug-resistant TB.
- Optimizing treatment strategies for pediatric DR-TB is essential to combat this global health threat.
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