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