Journal
EXPERT REVIEW OF RESPIRATORY MEDICINE
Volume 15, Issue 2, Pages 221-237Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/17476348.2021.1828069
Keywords
Tuberculosis; children; pediatric; prevention; treatment; resistant; multidrug-resistant
Categories
Funding
- UK Medical Research Council (MRC)
- UK Department or International Development (DFID) under the MRC/DFID Concordat agreement [MR/R007942/1]
- EDCTP2 program - European Union [99726 TB-Lung FACT TMA 2015 CDF - 1012]
- MRC [MR/R007942/1] Funding Source: UKRI
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The diagnosis and treatment of multidrug-resistant tuberculosis in children have historically been neglected, leading to a low proportion of diagnosed and treated cases. However, recent developments in diagnostic and therapeutic approaches have improved pediatric management. Further research and evidence-based practices are needed to enhance prevention and treatment strategies for children with MDR-TB.
Introduction An estimated 30,000 children develop multidrug-resistant (MDR) tuberculosis (TB) each year, with only a small proportion diagnosed and treated. This field has historically been neglected due to the perception that children with MDR-TB are challenging to diagnose and treat. Diagnostic and therapeutic developments in adults have improved pediatric management, yet further pediatric-specific research and wider implementation of evidence-based practices are required. Areas covered This review combines the most recent data with expert opinion to highlight best practice in the evaluation, diagnosis, treatment, and support of children and adolescents with MDR-TB disease. A literature search of PubMed was carried out on topics related to MDR-TB in children. This review provides practical advice on MDR-TB prevention and gives updates on new regimens and novel treatments. The review also addresses host-directed therapy, comorbid conditions, special populations, psychosocial support, and post-TB morbidity, as well as identifying outstanding research questions. Expert opinion Increased availability of molecular diagnostics has the potential to aid with the diagnosis of MDR-TB in children. Shorter MDR-TB disease treatment regimens have made therapy safer and shorter and further developments with novel agents and repurposed drugs should lead to additional improvements. The evidence base for MDR-TB preventive therapy is increasing.
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