High Cure Rates Among Children Treated for Multidrug-Resistant TB

October 16, 2013

By Will Boggs, MD

NEW YORK (Reuters Health) Oct 16 - More than 90% of children with multidrug-resistant tuberculosis (MDR-TB) can be treated successfully, according to a study from South Africa.

"I hope that this study will encourage people to diagnose and treat children with MDR-TB more readily," Dr. James A. Seddon from Stellenbosch University, Tygerberg, South Africa, and Imperial College London told Reuters Health. "In many countries in the world few, if any, children are treated. This is not because they do not exist, but because clinicians are wary of diagnosing MDR-TB in the absence of confirmation."

Children with MDR-TB commonly have limited, paucibacillary disease, including intrathoracic or extrathoracic lymph node disease, and they may have different responses -- good or bad -- to antimycobacterial drugs.

Dr. Seddon and colleagues used registry data to investigate the presentation, treatment, and outcome of MDR-TB in 149 children routinely treated for MDR-TB in Cape Town, South Africa.

Only 59 children (40%) had culture-confirmed diagnoses; 82 (55%) had probable disease, and eight (5%) had possible disease, according to the report, online September 24 in Thorax.

Just over two-thirds of the children (69%) were hospitalized for a median of five months. Ninety-four were treated with injectable drugs for four months, and the total treatment duration was 13 months.

Thirty-six children (24%) were cured, 101 (68%) were probably cured, one was transferred out, eight (5%) were lost to follow-up, and three (2%) died.

The 45 children with severe disease were significantly older (mean, 54 months) than the 104 children with non-severe disease (mean, 31.5 months) and less commonly had a MDR-TB source case identified. Children with severe disease also more commonly had HIV infection, extrapulmonary involvement, and poor nutritional status.

Children with severe disease were more likely than children with less severe disease to have a bacteriologically confirmed TB diagnosis, to be admitted to hospital, to be treated with injectable drugs, and to die.

"Limited, non-severe disease could be successfully treated with reduced treatment duration," the researchers say. "Further research in this regard is needed."

"I think that for children with severe disease, recommendations should continue to be as for adults," Dr. Seddon added. "However, I think we should think critically about how we manage children with more-limited disease."

"A one-size-fits-all approach to children with MDR-TB is probably not appropriate," he added. "Children with limited disease, if well, growing appropriately, with negative microbiology and improving imaging could be given shorter (or no) injectable treatment and could be considered for cessation of therapy at 12 months total."

Dr. Seddon added, "It is fair to say that the as the study took place in Cape Town and looked at South African children, caution should be exercised when drawing conclusions about the care of children in other countries treated in other health systems. However, the children in the study were varied in ethnicity, age, gender, nutritional status, HIV status and severity of disease. They were also treated in a government system in a middle-income country. Conclusions, if drawn cautiously, will likely be valid in different countries and health systems."

SOURCE: http://bit.ly/1cURXN8

Thorax 2013.


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