Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.
Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London , London, UK.
Expert Rev Respir Med. 2021 Feb;15(2):221-237. doi: 10.1080/17476348.2021.1828069. Epub 2020 Oct 10.
An estimated 30,000 children develop multidrug-resistant (MDR) tuberculosis (TB) each year, with only a small proportion diagnosed and treated. This field has historically been neglected due to the perception that children with MDR-TB are challenging to diagnose and treat. Diagnostic and therapeutic developments in adults have improved pediatric management, yet further pediatric-specific research and wider implementation of evidence-based practices are required.
This review combines the most recent data with expert opinion to highlight best practice in the evaluation, diagnosis, treatment, and support of children and adolescents with MDR-TB disease. A literature search of PubMed was carried out on topics related to MDR-TB in children. This review provides practical advice on MDR-TB prevention and gives updates on new regimens and novel treatments. The review also addresses host-directed therapy, comorbid conditions, special populations, psychosocial support, and post-TB morbidity, as well as identifying outstanding research questions.
Increased availability of molecular diagnostics has the potential to aid with the diagnosis of MDR-TB in children. Shorter MDR-TB disease treatment regimens have made therapy safer and shorter and further developments with novel agents and repurposed drugs should lead to additional improvements. The evidence base for MDR-TB preventive therapy is increasing.
每年估计有 3 万名儿童患有耐多药结核病（TB），但只有一小部分得到诊断和治疗。由于人们认为儿童耐多药结核病难以诊断和治疗，该领域在历史上一直被忽视。成人的诊断和治疗进展改善了儿科管理，但仍需要进一步开展儿科特定研究和更广泛地实施基于证据的实践。
本文结合最新数据和专家意见，强调了评估、诊断、治疗和支持患有耐多药结核病的儿童和青少年的最佳实践。对与儿童耐多药结核病相关的主题在 PubMed 上进行了文献检索。本综述就耐多药结核病的预防提供了实用建议，并更新了新方案和新疗法。本文还讨论了宿主定向治疗、合并症、特殊人群、社会心理支持和结核病后发病率，并确定了未解决的研究问题。
分子诊断的广泛应用有可能有助于儿童耐多药结核病的诊断。耐多药结核病治疗方案的缩短使治疗更安全、更短，新型药物和重新利用药物的进一步发展应能带来更多的改善。耐多药结核病预防性治疗的证据基础正在增加。
