哥伦比亚接触肺结核患者儿童的评估、治疗及随访临床实践指南
Clinical practice guideline for the evaluation, treatment, and follow-up of children in contact with patients with pulmonary tuberculosis in Colombia.
作者信息
Benjumea-Bedoya Dione, Robledo-Restrepo Jaime Alberto, Arbelaez-Montoya Maria Patricia, Estupiñán-Bohorquez Andres Felipe, Sabella-Jimenez Vanessa Sofia, Restrepo-Gouzy Andrea Victoria, Beltran-Arroyave Claudia Patricia, Bedoya-Giraldo Jairo, Niederbacher-Velasquez Jurg, Hurtado-Palacios Isabel Cristina, Cadavid-Álvarez Lina Marcela, Vanegas-Rojas Dora Elena, Murillo Tenorio Maribel, Paniagua-Saldarriaga Lizeth, Arteaga-Noriega Anibal Vicente, Sierra Javier M, Vélez Claudia Marcela, Botero-Garcés Jorge Humberto, Montes-Zuluaga Fernando Nicolas, Villegas-Arbelaez Esteban, Castaño-Osorio David, Andrade-Agudelo Victor Hugo, Pedraza-Moreno Lina Maria, Cruz-Martínez Oscar Andrés, Llerena-Polo Claudia, Gómez Andrea Juliana, Gil-Artunduaga Monica, Cataño María Lucia, Florez Ivan D
机构信息
Corporación Universitaria Remington Grupo de Investigación en Salud Familiar y Comunitaria Facultad de Ciencias de la Salud Corporación Universitaria Remington Medellín Colombia.
Corporación para Investiga. Biológicas Unidad de Bacteriología y Micobacterias Corporación para Investigaciones Biológicas Medellín Colombia.
出版信息
Colomb Med (Cali). 2025 Mar 30;56(1):e6005918. doi: 10.25100/cm.v56i1.5918. eCollection 2025 Jan-Mar.
INTRODUCTION
The available clinical practice guidelines on tuberculosis infection are not exclusive to the pediatric population.
OBJECTIVE
To formulate evidence-based recommendations for the evaluation, treatment, and follow-up of children in contact with patients with pulmonary tuberculosis in Colombia.
METHODS
A multidisciplinary development panel (composed by clinical and field experts, researchers, and methodologists who declared conflicts of interests), including patient representatives, and decision-makers formulated 10 questions and prioritized outcomes related to diagnosis (clinical evaluation, chest X-ray, and interferon-gamma release assays-IGRA), treatment (efficacy of regimens in different clinical scenarios), and follow-up (monitoring and strategies to increase adherence) for children exposed to tuberculosis. We conducted systematic literature reviews to identify guidelines, systematic reviews, and primary studies. We assessed these sources' quality and risk of bias with specific tools. We synthesized the evidence narratively and, in some cases, performed de novo meta-analyses (diagnostic and network meta-analyses). We evaluated the certainty of evidence using the GRADE system. We used the GRADE evidence-to-recommendation framework to formulate the recommendations.
RESULTS
We recommend 1) the use of IGRA tests to identify tuberculosis infection and chest X-rays to screen for active tuberculosis in children exposed to tuberculosis, 2) short instead of extended regimens for children with and without immunosuppression, 3) levofloxacin or susceptibility-guided regimens in cases of contact with drug-resistant tuberculosis, 4) monthly clinical follow-up during the treatment, 5) the implementation of comprehensive approaches to identify barriers to encourage treatment adherence.
CONCLUSIONS
The guideline panel provides context-specific, evidence-based recommendations for assessing and treating children exposed to tuberculosis in Colombia.
引言
现有的关于结核病感染的临床实践指南并非专门针对儿童群体。
目的
为哥伦比亚接触肺结核患者的儿童的评估、治疗及随访制定基于证据的建议。
方法
一个多学科制定小组（由声明存在利益冲突的临床和现场专家、研究人员及方法学家组成），包括患者代表和决策者，针对接触结核病的儿童，就诊断（临床评估、胸部X光和干扰素-γ释放试验-IGRA）、治疗（不同临床场景下治疗方案的疗效）及随访（监测和提高依从性的策略）提出了10个问题并确定了优先结果。我们进行了系统的文献综述以识别指南、系统评价和原始研究。我们使用特定工具评估这些来源的质量和偏倚风险。我们对证据进行了叙述性综合，在某些情况下还进行了全新的荟萃分析（诊断性和网状荟萃分析）。我们使用GRADE系统评估证据的确定性。我们使用GRADE证据到建议框架来制定建议。
结果
我们建议：1）对于接触结核病的儿童，使用IGRA检测来识别结核感染，使用胸部X光来筛查活动性结核病；2）对于有和没有免疫抑制的儿童，采用短疗程而非延长疗程；3）在接触耐多药结核病的情况下，使用左氧氟沙星或药敏指导的治疗方案；4）治疗期间每月进行临床随访；5）实施综合方法以识别阻碍因素，鼓励治疗依从性。
结论
该指南小组为评估和治疗哥伦比亚接触结核病的儿童提供了针对具体情况的、基于证据的建议。
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