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Diagnosis and Management of Multidrug-Resistant Tuberculosis in Children: A Practical Approach

  • H. Simon SchaafEmail author
Review Article

Abstract

Approximately 25,000 children develop multidrug-resistant (MDR) tuberculosis (TB) each year, but few of them are diagnosed and appropriately treated for MDR-TB. New diagnostic tools have improved our ability to diagnose children with bacteriologically confirmed TB earlier. However, the majority of childhood TB cases are not bacteriologically confirmed; therefore a high index of suspicion is needed, and taking a detailed history of contact with drug-resistant source cases and previous TB treatment is important to identify presumed MDR-TB cases. Treatment for MDR-TB is rapidly changing with the addition of new and repurposed drugs, the introduction of shorter regimens and the move towards injectable-free, all-oral MDR-TB treatment regimens. Children have been neglected in the introduction of the new drugs, but drug dosing and safety studies are now being completed. This article presents a practical approach in deciding which regimen to use in individual children in need of MDR-TB treatment. Outcomes in those treated are generally good, but only <5% of children with MDR-TB are currently diagnosed and appropriately treated. Diagnosing children with MDR-TB and getting them on to correct treatment regimens should now be our main focus.

Keywords

Tuberculosis Multidrug-resistant Children. Diagnosis Management 

Notes

Acknowledgement

The author acknowledges the help of Dr. Anthony J. Garcia–Prats for critically reviewing the manuscript.

Compliance with Ethical Standards

Conflict of Interest

HS Schaaf is co-investigator on a dose-finding and safety trial of Delamanid in children for which Stellenbosch University receives a per patient grant from Otsuka.

Source of Funding

HS Schaaf received financial support from the National Research Foundation (South Africa) for his research.

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Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  1. 1.Department of Pediatrics and Child Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa

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