ABSTRACT
BACKGROUND: Management of extensively drug-resistant tuberculosis (XDR-TB) and pre-XDR-TB is challenging, as effective drugs are lacking. Group 5 anti-tuberculosis drugs have an unclear role in the treatment of drug-resistant TB, and in children the efficacy, safety and effects of long-term use are not well described. We present clinical outcomes and adverse effects of a cohort of children with XDR-TB or pre-XDR-TB treated with Group 5 drugs in Tajikistan. METHODS: We conducted a retrospective analysis of eight children treated with one or more of the Group 5 drugs available under the Tajikistan National TB Programme-linezolid, amoxicillin-clavulanate, clofazimine and clarithromycin-given in combination with first- and second-line drugs. Time to sputum culture conversion, clinical outcomes and adverse effects were evaluated. RESULTS: Two children were cured, one completed treatment, four achieved favourable interim outcomes and one died. Adverse effects attributable to linezolid that required drug cessation occurred in one child; adverse effects of the other Group 5 drugs were insignificant or absent, requiring no regimen changes. CONCLUSION: Group 5 drugs can contribute to effective regimens in children with XDR and pre-XDR-TB. With proper monitoring and aggressive management of adverse effects, their safety profile might be acceptable, even in long-term use.
Subject(s)
Antitubercular Agents/therapeutic use , Extensively Drug-Resistant Tuberculosis/drug therapy , Adolescent , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Child , Child, Preschool , Clarithromycin/therapeutic use , Clofazimine/therapeutic use , Drug Combinations , Female , Follow-Up Studies , Humans , Linezolid/therapeutic use , Male , Retrospective Studies , Sputum/microbiology , Tajikistan , Treatment OutcomeABSTRACT
Guidelines for children with drug-resistant tuberculosis (DR-TB) tend to focus on individual patient care; there is little guidance for national tuberculosis programmes (NTPs) on how to plan, implement and integrate DR-TB services for children. In 2013, through the paediatric tuberculosis (TB) programme started by the Tajikistan Ministry of Health and Médecins Sans Frontières in 2011, 21 children became the first to be treated for multidrug-resistant tuberculosis (MDR-TB) in Tajikistan. We describe the challenges encountered in establishing the programme and the solutions to these challenges, and propose a framework to guide the implementation of paediatric DR-TB care. This framework could prove useful for other NTPs in resource-limited settings.
Les directives relatives aux enfants atteints de tuberculose pharmacorésistante (TB-DR) ont tendance à se focaliser sur la prise en charge des patients individuels; il y a par contre peu de directives destinées aux programmes nationaux de lutte contre la TB (PNT) sur la manière de planifier, mettre en Åuvre et intégrer les services de TB-DR destinés aux enfants. En 2013, dans un programme de prise en charge de la TB pédiatrique démarré par le Ministère de la Santé et Médecins Sans Frontières en 2011, 21 enfants ont été les premiers à être traités pour TB-MDR (TB multi-résistante) au Tadjikistan. Nous décrivons les défis de la mise en Åuvre d'un programme et de leurs solutions et proposons un cadre conceptuel d'aide à la mise en Åuvre de la prise en charge de la TB-DR pédiatrique. Notre cadre pourrait s'avérer utile pour d'autres PNT dans des contextes de ressources limitées.
Las directrices sobre el manejo de los niños con diagnóstico de tuberculosis drogorresistente (TB-MDR) suelen centrarse en la atención del paciente individual; existe poca orientación dirigida a los Programas Nacionales contra la Tuberculosis (PNT) en materia de planeamiento, ejecución e integración de los servicios que se ocupan de la TB-DR en los niños. El Ministerio de Salud y Médecins Sans Frontières iniciaron en el 2011 un programa de TB dirigido a los niños y en el 2013, por primera vez, 21 niños recibieron tratamiento contra la TB-MDR (multidrogorresistente) en Tayikistán. En el presente artículo se describen los obstáculos encontrados durante la introducción del programa, las soluciones que se aportaron y se propone un marco de trabajo encaminado a orientar la ejecución de la atención pediátrica de la TB-MDR. Este marco será útil a otros PNT en entornos con recursos limitados.
