a Medicins Sans Frontiers , Southern African Medical Unit , Cape Town , South Africa.
b Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA.
Expert Rev Respir Med. 2017 May;11(5):385-394. doi: 10.1080/17476348.2017.1309294. Epub 2017 Mar 28.
Drug-resistant tuberculosis (DR-TB) is a growing global health threat and children are especially vulnerable to becoming infected and sick with DR-TB. There is a growing body of evidence on the optimal diagnosis, treatment and prevention of DR-TB in this vulnerable population. Areas covered: A comprehensive review of the literature on DR-TB in children was done using PubMed and Ovid databases up to 31 December 2016. Topic areas covered included diagnosis of DR-TB, treatment of DR-TB - including novel medications and regimens, prevention of DR-TB, community-based care, and stigma/discrimination. After presenting a case that highlights some of these challenges in each of these areas, for which we will propose mechanisms for overcoming them. Expert commentary: Overcoming the challenges facing children with DR-TB, requires a paradigm shift at multiple levels. The 'trickle down' approach to pediatric DR-TB has been woefully inadequate and it is essential that pediatric DR-TB - preventing it, diagnosing it, and treating it - be made a priority.
耐多药结核病（DR-TB）是一个日益严重的全球健康威胁，儿童尤其容易感染和患耐多药结核病。目前有越来越多的证据表明，在这一弱势群体中，最佳的诊断、治疗和预防耐多药结核病的方法。
对截至 2016 年 12 月 31 日的 PubMed 和 Ovid 数据库中有关儿童耐多药结核病的文献进行了全面综述。涵盖的主题领域包括耐多药结核病的诊断、耐多药结核病的治疗——包括新型药物和方案、耐多药结核病的预防、基于社区的护理以及耻辱/歧视。在介绍了一个突出这些挑战在这些领域中的每一个方面的案例后，我们将提出克服这些挑战的机制。
克服耐多药结核病儿童面临的挑战，需要在多个层面上进行范式转变。针对儿科耐多药结核病的“涓滴效应”方法一直非常不足，必须将儿科耐多药结核病——预防、诊断和治疗——作为优先事项。
