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Updated: May 22, 2026
The MODS method for diagnosis of tuberculosis and multidrug resistant tuberculosis
Published on: August 11, 2008
Effectiveness and Safety of Contemporary Drug Regimens for Multidrug- and Extensively Drug-resistant Tuberculosis in
Wamaka Kaminyoge1, Reuben Simfukwe2, Mwiza Singini3
1From the Public Health Programme, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Insights
Newer all-oral regimens for pediatric multidrug-resistant tuberculosis (MDR-TB) are effective, with 91% success. While generally well-tolerated, further research is needed to fully understand the safety profile in children and adolescents.
Area of Science:
- Pediatric infectious diseases
- Global public health
- Pharmacology
Background:
- Children and adolescents with multidrug-resistant (MDR) or extensively drug-resistant (XDR) tuberculosis (TB) face significant treatment challenges.
- Current treatment guidelines for pediatric MDR/XDR-TB often extrapolate data from adult studies, overlooking critical biological and clinical differences.
- There is a lack of systematic, up-to-date evidence on the effectiveness and safety of contemporary TB regimens in younger populations.
Purpose of the Study:
- To conduct a global systematic review and meta-analysis to evaluate the effectiveness and safety of current pharmacologic treatment regimens for pediatric MDR/XDR-TB.
- To address the evidence gap regarding the use of newer, all-oral regimens in children and adolescents.
- To provide data to inform improved treatment guidelines and future research for pediatric TB.
Main Methods:
- Systematic search of major scientific databases (PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar) for studies published between January 1, 2015, and September 1, 2025.
- Inclusion of studies involving children aged 0-19 years diagnosed with confirmed or presumed MDR/XDR-TB or rifampicin-TB undergoing pharmacologic treatment.
- Random-effects meta-analysis to pool outcomes, with treatment success (cure or completion) as the primary outcome and severe (grade 3/4) adverse events as secondary outcomes.
Main Results:
- Analysis of 14 studies involving 490 children across 13 countries.
- Overall pooled treatment success rate of 89% (95% CI: 84%-93%).
- Newer all-oral regimens demonstrated higher treatment success (91%) compared to injectable-containing regimens (83%).
- Severe adverse events (grade 3/4) were infrequent, occurring in 21% of cases, with QT prolongation and anemia being the most common, though specific drug attribution was limited.
Conclusions:
- Newer, all-oral bedaquiline- and delamanid-based regimens are effective and generally well-tolerated for pediatric MDR/XDR-TB.
- The complete safety profile of these regimens in pediatric populations requires further characterization.
- The findings represent the most current evidence available for pediatric MDR/XDR-TB, offering a foundation for guideline development and future research.
Background:
Children and adolescents with multidrug-resistant (MDR) or extensively drug-resistant (XDR) tuberculosis (TB) face major treatment challenges. Although newer all-oral regimens have transformed adult TB care, their use in younger populations has largely been extrapolated from adult studies, despite important biologic and clinical differences. Systematic and up-to-date evidence on the effectiveness and safety of contemporary regimens in children and adolescents is lacking. We conducted a global systematic review and meta-analysis to address this gap.
Methods:
We systematically searched PubMed, EMBASE, Web of Science, Cochrane Library and Google Scholar for studies published between January 1, 2015, and September 1, 2025. Eligible studies included children 0-19 years old with confirmed or presumed MDR/XDR-TB or rifampicin-TB receiving pharmacologic treatment. Outcomes were pooled using a random-effects meta-analysis. The primary outcome was treatment success (cure or completion); severe (grade 3/4) adverse events were assessed as secondary outcomes.
Results:
We included 14 studies comprising 490 children across 13 countries. Overall pooled treatment success was 89% (95% confidence interval: 84%-93%; I2 = 51.9%). Newer all-oral regimens achieved slightly higher success (91%) than injectable-containing regimens (83%). Severe grade 3/4 adverse event were sparse (7 of 14 studies); events occurred in 21% (95% confidence interval: 13%-33%), most commonly QT prolongation and anemia, with limited specific drug attribution.
Conclusions:
Newer, all-oral bedaquiline- and delamanid-based regimens for pediatric MDR/XDR-TB are effective and generally well tolerated, though the full safety profile remains incompletely characterized. In pediatric MDR/XDR-TB, where studies are rare, our findings provide the best available evidence and a foundation for improved treatment guidelines and future research.
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