Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, , Tygerberg, South Africa.
Thorax. 2014 May;69(5):458-64. doi: 10.1136/thoraxjnl-2013-203900. Epub 2013 Sep 24.
Few studies have described the management of multidrug-resistant (MDR) tuberculosis (TB) in children and evidence-based guidance on management is lacking. We describe the presentation, treatment and outcome in children treated for severe and non-severe MDR-TB in Cape Town, South Africa.
We conducted an observational cohort study of all children (<15 years) treated for MDR-TB if routinely initiated on treatment between January 2009 and December 2010. Treatment was based on local standard of care, based on international guidelines. Data were collected through family interviews and folder review. Standardised definitions were used for diagnosis, severity of disease, adverse events and outcome.
Of 149 children started on MDR-TB treatment, the median age was 36 months (IQR 16-66), 32 (22%; of 146 tested) had HIV infection and 59 (40%) had a confirmed diagnosis. Ninety-four (66%) children were treated with an injectable drug and the median total duration of treatment was 13 months (IQR 11-18). Thirty-six (24%) children were cured, 101 (68%) probably cured, 1 (1%) was transferred out, 8 (5%) were lost to follow-up and 3 (2%) died. Children with severe disease were older (54 months (IQR 18-142) vs 31.5 months (IQR 17.5-53.5); p=0.012), more commonly had HIV infection (OR 6.25; 95% CI 2.50 to 15.6; p<0.001) and were more likely to die (p=0.008).
A confirmed diagnosis of MDR-TB is not possible in all cases but this should not impede the treatment of MDR-TB in children. More than 90% of children with MDR-TB can be successfully treated. Non-severe disease could be successfully treated with reduced treatment duration.
很少有研究描述儿童耐多药（MDR）结核病（TB）的管理，并且缺乏基于证据的管理指南。我们描述了在南非开普敦接受严重和非严重 MDR-TB 治疗的儿童的临床表现、治疗和结局。
我们对 2009 年 1 月至 2010 年 12 月期间常规开始治疗的所有（<15 岁）MDR-TB 患儿进行了一项观察性队列研究。治疗基于国际指南的当地标准护理。通过家庭访谈和文件夹审查收集数据。采用标准化定义诊断、疾病严重程度、不良事件和结局。
在开始 MDR-TB 治疗的 149 名儿童中，中位年龄为 36 个月（IQR 16-66），32 名（146 名检测者中的 22%）感染了 HIV，59 名（40%）有确诊的诊断。94 名（66%）儿童接受了注射药物治疗，中位总治疗时间为 13 个月（IQR 11-18）。36 名（24%）儿童治愈，101 名（68%）可能治愈，1 名（1%）转院，8 名（5%）失访，3 名（2%）死亡。严重疾病患儿年龄较大（54 个月（IQR 18-142）vs. 31.5 个月（IQR 17.5-53.5）；p=0.012），更常见 HIV 感染（OR 6.25；95%CI 2.50-15.6；p<0.001），更有可能死亡（p=0.008）。
并非所有病例都能确诊 MDR-TB，但这不应妨碍儿童 MDR-TB 的治疗。超过 90%的 MDR-TB 患儿可以成功治疗。非严重疾病可通过缩短治疗时间成功治疗。
