School of Health Sciences, University of Kwazulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
BMC Pediatr. 2024 Aug 12;24(1):520. doi: 10.1186/s12887-024-04985-8.
Children represent a particularly vulnerable demographic in the context of drug-resistant (DR) tuberculosis (TB) due to their increased likelihood of close contact with adults diagnosed with the disease. Approximately 25 000-30 000 children develop DR-TB annually. While treatment success rates for DR-TB in children surpass those in adults, children and adolescents encounter distinct challenges throughout the diagnosis and treatment of DR-TB (including MDR-TB, Pre-XDR TB, and XDR-TB).
To identify current practices in drug administration to children diagnosed with DR-TB where appropriate dosage forms are not available in South Africa.
An observational study was carried out at the study site to determine how medication prescribed was manipulated and administered by nursing staff to paediatric patients in the wards.
The observational study identified 8 drugs used in DR-TB at the study site, where some manipulation to the formulation was necessary to enable administration to paediatric patients. Linezolid and para-aminosalicylic acid are the only drugs available and registered in the South Africa in a formulation that is suitable for administration to paediatric patients. Activities carried out by nursing staff to enable the administration of DR-TB medication included cutting capsules and tablets and dissolving the tablet or capsule contents in distilled water to obtain the required suitable dose.
Lack of availability of suitable dosage forms for paediatrics patients results in several challenges, such as additional time required for drug preparation, increased time duration of medication administration, and unpalatability of drugs. These challenges may subsequently affect compliance and therapeutic outcomes of the treatment of paediatric patients, especially as outpatients.
Research needs to focus on the development of appropriate dosage forms for the paediatric population and focus on identifying cases of DR-TB in children. This will assist in building evidence to advocate for registration of child-friendly dosage forms thereby ensuring a sustainable supply of medication.
在耐药结核病（DR-TB）方面，儿童是一个特别脆弱的群体，因为他们与被诊断出患有该疾病的成年人密切接触的可能性增加。每年约有 25000-30000 名儿童发展为 DR-TB。虽然儿童 DR-TB 的治疗成功率高于成人，但儿童和青少年在诊断和治疗 DR-TB（包括耐多药结核病、预广泛耐药结核病和广泛耐药结核病）时会遇到独特的挑战。
确定在南非不提供适当剂型的情况下，为诊断为 DR-TB 的儿童提供药物的当前做法。
在研究现场进行了一项观察性研究，以确定病房护士如何操纵和管理规定的药物，以治疗儿科患者。
观察性研究确定了在研究现场使用的 8 种用于 DR-TB 的药物，其中一些药物需要进行制剂处理，以便能够向儿科患者给药。利奈唑胺和对氨基水杨酸是唯一在南非注册并以适合儿科患者给药的剂型提供的药物。护理人员为使 DR-TB 药物能够给药而开展的活动包括切割胶囊和片剂，并将片剂或胶囊内容物溶解在蒸馏水中，以获得所需的适当剂量。
缺乏适合儿科患者的剂型会带来多种挑战，例如药物准备所需的额外时间、增加药物给药的持续时间以及药物的口感不佳。这些挑战可能会随后影响治疗儿科患者的依从性和治疗结果，尤其是作为门诊患者。
研究需要专注于为儿科人群开发适当的剂型，并专注于识别儿童中的 DR-TB 病例。这将有助于建立证据，倡导注册适合儿童使用的剂型，从而确保药物的可持续供应。
