Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
Pediatr Infect Dis J. 2013 May;32(5):e217-26. doi: 10.1097/INF.0b013e3182865409.
Isoniazid resistance is an obstacle to the treatment of tuberculosis disease and latent tuberculosis infection in children. We aim to summarize the literature describing the risk of isoniazid-resistant tuberculosis among children with tuberculosis disease.
We did a systematic review of published reports of children with tuberculosis disease who had isolates tested for susceptibility to isoniazid. We searched PubMed, Embase and LILACS online databases up to January 12, 2012.
Our search identified 3403 citations, of which 95 studies met inclusion criteria. These studies evaluated 8351 children with tuberculosis disease for resistance to isoniazid. The median proportion of children found to have isoniazid-resistant strains was 8%; the distribution was right-skewed (25th percentile: 0% and 75th percentile: 18%).
High proportions of isoniazid resistance among pediatric tuberculosis patients have been reported in many settings suggesting that diagnostics detecting only rifampin resistance are insufficient to guide appropriate treatment in this population. Many children are likely receiving substandard tuberculosis treatment with empirical isoniazid-based regimens, and treating latent tuberculosis infection with isoniazid may not be effective in large numbers of children. Work is needed urgently to identify effective regimens for the treatment of children sick with or exposed to isoniazid-resistant tuberculosis and to better understand the scope of this problem.
异烟肼耐药是儿童结核病和潜伏性结核感染治疗的障碍。我们旨在总结描述结核病患儿异烟肼耐药风险的文献。
我们对已发表的结核病患儿培养物异烟肼药敏试验的报告进行了系统性回顾。我们检索了 PubMed、Embase 和 LILACS 在线数据库，检索截至 2012 年 1 月 12 日。
我们的检索共确定了 3403 条引文，其中 95 项研究符合纳入标准。这些研究评估了 8351 例结核病患儿的异烟肼耐药性。发现异烟肼耐药株的患儿比例中位数为 8%；分布呈右偏态（25%分位数：0%，75%分位数：18%）。
许多环境中都报告了儿童结核病患者中存在较高比例的异烟肼耐药性，这表明仅检测利福平耐药性的诊断方法不足以指导该人群的适当治疗。许多儿童可能正在接受经验性异烟肼为基础的方案进行不合标准的结核病治疗，并且在大量儿童中，用异烟肼治疗潜伏性结核感染可能无效。急需开展工作，以确定治疗患有或接触异烟肼耐药结核病的儿童的有效方案，并更好地了解这一问题的范围。
