Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Indian J Pediatr. 2024 Aug;91(8):806-816. doi: 10.1007/s12098-023-04888-z. Epub 2023 Nov 23.
Optimal diagnosis and management of children aged <15 y with rifampicin- or multidrug-resistant tuberculosis (RR/MDR-TB) relies on identification of adults with the disease and pro-active screening of their close contacts. Children may be diagnosed with RR/MDR-TB based on microbiological confirmation from clinical specimens (sputum, gastric washings, stool), but usually the diagnosis is presumptive, with a history of exposure to RR/MDR-TB and clinical/radiological signs and symptoms suggestive of TB disease. RR/MDR-TB should also be considered in children where first-line TB treatment fails despite good adherence to therapy. Composition and duration of all-oral RR/MDR-TB treatment regimens in children are based on site and severity of TB disease, drug resistance profile of the Mycobacterium tuberculosis strain (isolated from the child or from the most likely source patient), inclusion of at least four drugs considered to be effective (with priority given to World Health Organization Group A and B drugs), toxicity and tolerability of medications (and feasibility of adverse effect monitoring in the child's setting), and availability of child-friendly formulations of TB medications. Individualized RR/MDR-TB regimens are preferable to the standardised 9-12-mo regimen for children, and injectable agents must not be used. Optimal adherence to treatment relies on education, training and support for caregivers and others who are responsible for administering medications to children, as well as close clinical monitoring and early management of adverse effects. Children who are initiated on adequate RR/MDR-TB regimens have high treatment success rates, but efforts to find and treat more children with undiagnosed RR/MDR-TB are crucial to reduce childhood TB mortality.
<15 岁儿童利福平或耐多药结核病（RR/MDR-TB）的最佳诊断和管理依赖于识别患有该病的成人，并积极筛查其密切接触者。儿童可能通过临床标本（痰、胃液、粪便）的微生物学确认来诊断 RR/MDR-TB，但通常诊断是推测性的，有 RR/MDR-TB 接触史，以及临床/影像学提示结核病的迹象和症状。即使儿童对治疗有良好的依从性，一线结核病治疗失败后，也应考虑 RR/MDR-TB。儿童全口服 RR/MDR-TB 治疗方案的组成和持续时间基于结核病的部位和严重程度、结核分枝杆菌株的耐药谱（从儿童或最可能的源患者中分离）、至少包含四种被认为有效的药物（优先考虑世界卫生组织 A 组和 B 组药物）、药物的毒性和耐受性（以及在儿童环境中监测不良反应的可行性），以及儿童友好型抗结核药物的制剂。与儿童标准的 9-12 个月方案相比，个体化 RR/MDR-TB 方案更可取，且不能使用注射剂。最佳的治疗依从性依赖于对照顾者和负责给儿童用药的其他人的教育、培训和支持，以及密切的临床监测和早期处理不良反应。开始接受充分 RR/MDR-TB 方案治疗的儿童有很高的治疗成功率，但找到并治疗更多未确诊的 RR/MDR-TB 儿童的努力对于降低儿童结核病死亡率至关重要。
