Getting it right for children: improving tuberculosis treatment access and new treatment options

Abstract

Children were often the forgotten victims of the global tuberculosis (TB) epidemic, neglected by traditional TB services as well as maternal and child health initiatives. Luckily this is changing with a greater focus on children and the issues regarding their optimal management. A common misconception is that children with TB are always difficult to diagnose and treat. New diagnostic tools are urgently needed, but most children with TB in high-burden settings can be diagnosed with available approaches and treatment outcomes are generally excellent. Increased TB awareness, appropriate training of health care workers and inclusion in integrated management of childhood illness strategies will improve the access and quality of care that children receive. This review highlights what needs to be done to ensure that no child unnecessarily dies from TB and provides a brief overview of new advances in the field.

Keywords:

• children
• pediatric tuberculosis
• prevention
• treatment options
• tuberculosis

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Diagnosing children with tuberculosis (TB) is relatively uncomplicated in most instances. Diagnostic algorithms should reflect this. Bacterial confirmation is more challenging, but is possible in most children if appropriate samples are obtained and tested (prioritizing culture over smear).

• Awaiting bacteriological confirmation should not unnecessarily delay treatment, especially in sick, HIV co-infected or malnourished children. Appropriate history taking and knowledge of the likely index case identify those at risk of drug-resistant forms of TB.

• Household contact screening and TB prevention should be better implemented, especially in TB-endemic areas where this is often not even attempted. Vaccine development should retain a strong focus on the protection of young and vulnerable children.

• Dissolvable fixed-dose combination tablets work well in children. New quality assured pediatric fixed-dose combinations, with optimal first-line drug ratios, are expected to be available in 2015. It is vital that this is taken up by country programs.

• HIV and nutritional screening is essential in all children diagnosed with TB, with appropriate integration of TB, HIV and other child health services.

• Young children usually have pauci-bacillary disease, which mean that they may be cured with shorter treatment regimens. This requires further evaluation.

• New drug and regimen trials should all have pediatric components, at least to assess safety and pharmacokinetic profiles in children and develop child-friendly formulations.

• Low- and middle-income countries need to invest more in child health, including the provision of TB care to children.