Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Gauteng, South Africa.
Paediatr Drugs. 2011 Dec 1;13(6):349-55. doi: 10.2165/11593160-000000000-00000.
This article was based on a presentation given at the 26th International Pediatric Association Conference of Pediatrics, Johannesburg, South Africa, 4-9 August 2010. In 2009, there were 9.4 million new cases of tuberculosis (TB) globally, and, of these, approximately 1 million were pediatric cases. Drug-resistant TB makes up a relatively small proportion of new TB cases, but is much more likely in previously treated cases. Pediatric TB remains difficult to diagnose microbiologically, with the result that detection of drug-resistant TB in children is an ongoing challenge. Since children diagnosed with TB predominantly represent recently acquired TB infection, they provide an important indication of drug-resistant TB prevalence and transmission within their communities. Drug-resistant TB is essentially a man-made problem, which consumes large amounts of healthcare resources. Recent technologic advances may pave the way to more rapid and accurate diagnosis of TB in children. Similarly, these advances are likely to result in improved detection of drug-resistant pediatric TB isolates. The treatment of pediatric drug-resistant TB requires prolonged courses of expensive and potentially toxic drugs, many of which are not available in child-friendly formulations. New anti-TB drugs are at various stages of pre-clinical development and will hopefully allow for shorter, more effective treatment regimens in the not too distant future. HIV-infected children are at extremely high risk for TB acquisition and subsequent progression to symptomatic disease; therefore, many cases of pediatric drug-resistant TB occur in HIV-infected children. This often results in complicated pharmacologic regimens (including anti-TB and antiretroviral drugs) that are difficult to comply with and may have unpredictable interactions. There are limited reports of long-term clinical outcomes of children diagnosed with drug-resistant TB, but improvements in the diagnosis and pharmacologic management of these cases have the potential to improve the quality of care offered to these children.
本文基于在南非约翰内斯堡举行的第 26 届国际儿科学会大会上的一次演讲。2009 年，全球有 940 万例新结核病（TB）病例，其中约 100 万例为儿科病例。耐多药结核病在新结核病病例中所占比例相对较小，但在既往治疗过的病例中更为常见。儿科结核病在微生物学上仍然难以诊断，因此，儿童中耐药结核病的检测仍然是一个持续存在的挑战。由于诊断为结核病的儿童主要代表新近获得的结核病感染，因此他们是其所在社区内耐药结核病流行和传播的重要指示。耐多药结核病本质上是一个人为造成的问题，消耗了大量的医疗保健资源。最近的技术进步可能为儿童结核病的更快速和更准确诊断铺平道路。同样，这些进步也可能更有助于发现耐药性儿科结核病分离株。治疗儿科耐多药结核病需要长期使用昂贵且可能有毒的药物，其中许多药物不适用于儿童。新的抗结核药物处于不同的临床前开发阶段，有望在不远的将来实现更短、更有效的治疗方案。感染 HIV 的儿童感染结核病和随后发展为有症状疾病的风险极高；因此，许多儿科耐多药结核病病例发生在 HIV 感染儿童中。这通常导致复杂的药物治疗方案（包括抗结核和抗逆转录病毒药物），难以遵守，并且可能具有不可预测的相互作用。有关诊断为耐药性结核病的儿童的长期临床结局的报告有限，但这些病例的诊断和药物管理的改进有可能改善为这些儿童提供的护理质量。
