Managing drug-resistant Tuberculosis in Children

Treating children with undiagnosed RR/MDR-TB is crucial to reduce childhood TB mortality. Optimal diagnosis and management of children under 15 years old with rifampicin- or multidrug-resistant tuberculosis (RR/MDR-TB) depend on identifying adults with the disease and proactively screening their close contacts.

Children may be diagnosed with RR/MDR-TB via microbiological confirmation from clinical specimens (sputum, gastric washings, stool). However, the diagnosis is often presumptive, based on exposure history to RR/MDR-TB and clinical/radiological signs suggestive of TB disease.

Treatment:

RR/MDR-TB should be considered in children where first-line TB treatment fails despite good adherence to therapy. The composition and duration of all-oral RR/MDR-TB treatment regimens in children are determined by:

• Site and severity of TB disease.
• Drug resistance profile of the M. tuberculosis strain (from the child or the most likely source patient).
• The inclusion of at least four drugs is considered effective, prioritizing World Health Organization Group A and B drugs.
• Toxicity, tolerability, and feasibility of adverse effect monitoring.
• Availability of child-friendly formulations of TB medications.

Individualized RR/MDR-TB regimens should be preferred over the standardized 9–12-month regimen for children. Injectable agents should not be used in children with RR/MDR-TB.

Optimal adherence to treatment relies on education, training, and support for caregivers and those responsible for administering medications; and close clinical monitoring and early management of adverse effects.

Children who receive adequate RR/MDR-TB regimens have high treatment success rates.

Schaaf HS, Hughes J. Current Treatment of Drug-Resistant Tuberculosis in Children. Indian J Pediatr. 2024; 91:806–816. https://doi.org/10.1007/s12098-023-04888-z