Mukherjee Aparna, Lodha Rakesh, Kabra Sushil Kumar
a Department of Pediatrics , All India Institute of Medical Sciences , New Delhi , India.
Expert Opin Pharmacother. 2017 Oct;18(15):1595-1606. doi: 10.1080/14656566.2017.1373090. Epub 2017 Oct 9.
Multidrug-resistant tuberculosis (MDR-TB) is a serious life threatening condition affecting children as well as adults worldwide. Timely diagnosis and effective treatment, both of which are complex in children, are the prerogatives for a favorable outcome. Areas covered: This review covers epidemiology, treatment regimen and duration, newer drugs and adverse events in children with MDR-TB. Special note has been made of epidemiology and principles of treatment followed in Indian children. Expert opinion: High index of suspicion is essential for diagnosing childhood MDR-TB. If there is high probability, a child can be diagnosed as presumptive MDR-TB and started on empiric treatment in consultation with experts. However, every effort should be made to confirm the diagnosis. Backbone of an effective MDR-TB regimen consists of four 2nd line anti-TB drugs plus pyrazinamide; duration being 18-24 months. The newer drugs delamanid and bedaquiline can be used in younger children if no other alternatives are available after consultation with experts. Wider availability of these drugs should be ensured for benefit to all concerned. More research is required for development of new and repurposed drugs to combat MDR-TB. Children need to be included in clinical trials for such life-saving drugs, so that nobody is denied the benefits.
耐多药结核病（MDR-TB）是一种严重威胁生命的疾病，影响着全球的儿童和成人。及时诊断和有效治疗在儿童中都很复杂，是取得良好预后的前提。涵盖领域：本综述涵盖了儿童耐多药结核病的流行病学、治疗方案和疗程、新型药物及不良事件。特别关注了印度儿童的流行病学及治疗原则。专家意见：高度怀疑对于诊断儿童耐多药结核病至关重要。如果可能性很大，可将儿童诊断为疑似耐多药结核病，并在与专家协商后开始经验性治疗。然而，应尽一切努力确诊。有效的耐多药结核病治疗方案的核心由四种二线抗结核药物加吡嗪酰胺组成；疗程为18 - 24个月。如果在与专家协商后没有其他选择，新型药物地拉曼尼和贝达喹啉可用于年幼儿童。应确保这些药物更广泛地供应，以使所有相关人员受益。需要开展更多研究以开发新的和重新利用的药物来对抗耐多药结核病。儿童应被纳入此类救命药物的临床试验，以便没有人被剥夺受益的机会。
