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ABSTRACT
Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a serious life threatening condition affecting children as well as adults worldwide. Timely diagnosis and effective treatment, both of which are complex in children, are the prerogatives for a favorable outcome.
Areas covered: This review covers epidemiology, treatment regimen and duration, newer drugs and adverse events in children with MDR-TB. Special note has been made of epidemiology and principles of treatment followed in Indian children.
Expert opinion: High index of suspicion is essential for diagnosing childhood MDR-TB. If there is high probability, a child can be diagnosed as presumptive MDR-TB and started on empiric treatment in consultation with experts. However, every effort should be made to confirm the diagnosis. Backbone of an effective MDR-TB regimen consists of four 2nd line anti-TB drugs plus pyrazinamide; duration being 18–24 months. The newer drugs delamanid and bedaquiline can be used in younger children if no other alternatives are available after consultation with experts. Wider availability of these drugs should be ensured for benefit to all concerned. More research is required for development of new and repurposed drugs to combat MDR-TB. Children need to be included in clinical trials for such life-saving drugs, so that nobody is denied the benefits.
Article highlights
MDR-TB is a serious problem affecting children all over the world today.
In children, high index of suspicion is needed for diagnosing MDR-TB. Because of the paucibacillary nature of the disease and difficulty in obtaining appropriate specimens, many a times MDR-TB cannot be confirmed. However, in the presence of active TB not responding to 1st line ATT, with history of contact with confirmed or suspected case of MDR-TB, empiric treatment may be started. Every effort should be made to confirm the microbiological diagnosis of TB and resistance.
Rapid diagnostic tests for confirmation of Mycobacterium tuberculosis in clinical samples and detection of resistance to rifampicin, INH, fluoroquinolones and second line injectables should be widely available and used for the timely diagnosis of MDR-TB in children, so that initiation of appropriate treatment is not delayed.
An effective MDR-TB regimen consists of at least 5 drugs: four 2nd line anti-TB drugs which are likely to be effective and pyrazinamide.
Delamanid can be considered from 3 years onwards after consulting with experts. Similarly, bedaquiline can be considered 12 years onwards on a case to case basis.
Strict monitoring of adverse events is essential while a child is on 2nd line ATT.
This box summarizes key points contained in the article.
Declaration of interest
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.