Pecora Francesco, Dal Canto Giulia, Veronese Piero, Esposito Susanna
Pediatric Clinic, Department of Medicine and Surgery, Pietro Barille Children's Hospital, University Hospital of Parma, 43126 Parma, Italy.
Microorganisms. 2021 May 17;9(5):1074. doi: 10.3390/microorganisms9051074.
Multidrug-resistant (MDR) tuberculosis (TB) has been emerging at an alarming rate over the last few years. It has been estimated that about 3% of all pediatric TB is MDR, meaning about 30,000 cases each year. Although most children with MDR-TB can be successfully treated, up to five years ago effective treatment was associated with a high incidence of severe adverse effects and patients with extensively drug-resistant (XDR) TB had limited treatment options and no standard regimen. The main objective of this manuscript is to discuss our present knowledge of the management of MDR- and XDR-TB in children, focusing on the characteristics and available evidence on the use of two promising new drugs: bedaquiline and delamanid. PubMed was used to search for all of the studies published up to November 2020 using key words such as "bedaquiline" and "delamanid" and "children" and "multidrug-resistant tuberculosis" and "extensively drug-resistant tuberculosis". The search was limited to articles published in English and providing evidence-based data. Although data on pediatric population are limited and more studies are needed to confirm the efficacy and safety of bedaquiline and delamanid, their use in children with MDR-TB/XDR-TB appears to have good tolerability and efficacy. However, more evidence on these new anti-TB drugs is needed to better guide their use in children in order to design effective shorter regimens and reduce adverse effects, drug interactions, and therapeutic failure.
在过去几年中，耐多药（MDR）结核病（TB）一直在以惊人的速度出现。据估计，所有儿童结核病中约3%为耐多药，即每年约30000例。虽然大多数耐多药结核病儿童可以得到成功治疗，但直到五年前，有效治疗仍伴随着严重不良反应的高发生率，而广泛耐药（XDR）结核病患者的治疗选择有限且没有标准治疗方案。本手稿的主要目的是讨论我们目前对儿童耐多药和广泛耐药结核病管理的认识，重点关注两种有前景的新药：贝达喹啉和地拉曼的使用特点及现有证据。使用PubMed检索截至2020年11月发表的所有研究，关键词如“贝达喹啉”“地拉曼”“儿童”“耐多药结核病”“广泛耐药结核病”。检索仅限于以英文发表并提供循证数据的文章。尽管关于儿科人群的数据有限，还需要更多研究来证实贝达喹啉和地拉曼的疗效和安全性，但它们在耐多药/广泛耐药结核病儿童中的使用似乎具有良好的耐受性和疗效。然而，需要更多关于这些新型抗结核药物的证据，以更好地指导它们在儿童中的使用，从而设计出有效的更短疗程方案，并减少不良反应、药物相互作用和治疗失败。
