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Clinical standards for drug-susceptible TB in children and adolescents
S S Chiang1, S M Graham2, H S Schaaf3
1Division of Pediatric Infectious Diseases, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, Center for International Health Research, Rhode Island Hospital, Providence, RI, USA.
Insights
New clinical standards offer guidance for managing drug-susceptible tuberculosis (TB) in children and adolescents. These expert-endorsed guidelines emphasize prompt evaluation, tailored treatment, and supportive care to improve outcomes for pediatric TB patients.
Area of Science:
- Pediatric Infectious Diseases
- Global Health
- Clinical Practice Guidelines
Background:
- Drug-susceptible tuberculosis (TB) poses unique challenges in pediatric populations.
- Existing clinical guidance for pediatric TB management requires updates.
Purpose of the Study:
- To establish evidence-based clinical standards for the diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.
- To provide a framework for healthcare professionals to optimize care for pediatric TB cases.
Main Methods:
- A Delphi consensus process involving 52 global pediatric TB experts.
- Eight rounds of revisions and review to achieve expert consensus.
- Final document endorsed by 98% of participating experts.
Main Results:
- Eight key clinical standards were identified and endorsed.
- Standards cover age-specific assessment, prompt diagnosis without mandatory microbiological confirmation, urgent treatment for severe forms (meningitis, miliary TB), weight-based regimens, treating TB infection (TBI), home-based support, age-appropriate family support, and robust case reporting/contact tracing.
- Emphasis on individualized and supportive care approaches.
Conclusions:
- Consensus-based clinical standards can significantly improve the care of children and adolescents with TB.
- Adaptation of these standards to local contexts is crucial for effective implementation.
- These guidelines aim to enhance clinical outcomes and engagement in care for pediatric TB patients.
Abstract:
BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.
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