Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, and Tygerberg Children's Hospital, Cape Town, South Africa.
Paediatr Respir Rev. 2011 Mar;12(1):31-8. doi: 10.1016/j.prrv.2010.09.010. Epub 2010 Oct 14.
WHO estimated that of 9.4 million cases of tuberculosis (TB) worldwide in 2008, 440,000 (3.6%) had multidrug-resistant (MDR)-TB. Childhood TB is estimated at 10-15% of the total burden, but little is known about the burden of MDR-TB in children. Children in close contact with MDR-TB cases are likely to become infected with the same resistant strains and are vulnerable to develop disease. Although MDR-TB is a microbiological diagnosis, children should be treated empirically according to the drug susceptibility result of the likely source case, as often cultures cannot be obtained from the child. MDR-TB treatment in children is guided by the same principles, using the same second-line drugs as in adults, with careful monitoring for adverse effects. Co-infection with HIV poses particular challenges and requires early initiation of antiretroviral therapy. Preventive therapy for high-risk MDR-TB contacts is necessary, but no consensus guidance exists on how best to manage these cases. Pragmatic and effective Infection control measures are essential to limit the spread of MDR-TB.
世界卫生组织估计，2008 年全球有 940 万例结核病（TB）病例，其中 44 万例（3.6%）为耐多药（MDR）-TB。儿童结核病约占总负担的 10-15%，但对儿童中 MDR-TB 的负担知之甚少。与 MDR-TB 病例密切接触的儿童很可能感染相同的耐药菌株，并容易患病。虽然 MDR-TB 是一种微生物学诊断，但由于通常无法从儿童中获得培养物，因此应根据可能来源病例的药敏结果进行经验性治疗。儿童 MDR-TB 的治疗遵循相同的原则，使用与成人相同的二线药物，并密切监测不良反应。合并感染 HIV 带来了特殊的挑战，需要及早开始抗逆转录病毒治疗。有必要对高危 MDR-TB 接触者进行预防性治疗，但目前尚无关于如何最好地管理这些病例的共识指南。切实有效的感染控制措施对于限制 MDR-TB 的传播至关重要。
