A clinician's guide to managing multidrug-resistant tuberculosis in children and adolescents

A small fraction of the estimated 25,000-30000 children (<15 years) who develop multidrug-resistant (MDR) tuberculosis (TB) globally every year are diagnosed and started on appropriate treatment. However, recent years have brought rapid changes to diagnostics, prevention, and treatment strategies.

We present current data on pediatric and adolescent MDR-TB combined with expert opinion to guide the reader through the pediatric and adolescent MDR-TB care cascade. This includes background information and practical guidance on the disease, the epidemiology, diagnostics, treatment options, and post MDR-TB sequalae. We also address the special circumstances of adolescents, comorbidities, and the socioeconomic impact of MDR-TB. PubMed was searched for suitable articles and national and international guidelines were reviewed.

The roll-out of low complexity molecular diagnostics and advanced techniques, such as targeted next-generation sequencing, have the potential to rapidly diagnose children and adolescents with MDR-TB. The recently introduced short-all oral regimens provide safer and shorter treatment options. The effectiveness of levofloxacin as MDR-TB preventive treatment has been demonstrated. However, wide implementation of such new and advanced tools is still pending and improvements in diagnostics are crucial to increasing the proportion of children and adolescents with MDR-TB being diagnosed.