ABSTRACT
SETTING: Few data on drug-resistant (DR) tuberculosis (TB) in children are available in Thailand. OBJECTIVES: To evaluate the rate, clinical features and risk of DR-TB in children. DESIGN: Observational prospective study conducted in children diagnosed with TB at a tertiary care centre in Bangkok. RESULTS: Of 230 children diagnosed with TB, the median age was 6.5 years; 63% had identified adult source cases, and only 7% had received prior isoniazid treatment for latent tuberculous infection. Of the 195 (85%) specimens submitted, 57 (25%) were positive using culture or polymerase chain reaction. Of the 53 positive specimens available for drug susceptibility testing (DST), 18 (34%) had any resistance, 13 (24.5%) were mono-resistant, 2 (3.8%) polyresistant and 3 (5.7%) were multidrug-resistant. In multivariate analysis, prior TB treatment (P < 0.001), presence of atelectasis (P = 0.039) or lobar consolidation (P = 0.012) on chest X-ray were associated with DR-TB. DR-TB required longer treatment but there were no differences in rate of cure, treatment completion or death. CONCLUSIONS: The high rate of DR-TB underscores the importance of routine DST. History of treatment and drug susceptibility in source cases was useful in guiding initial treatment in children.
Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Multidrug-Resistant/epidemiology , Tuberculosis/epidemiology , Adolescent , Antitubercular Agents/administration & dosage , Antitubercular Agents/pharmacology , Child , Child, Preschool , Drug Resistance, Bacterial , Female , Humans , Infant , Infant, Newborn , Isoniazid/therapeutic use , Male , Microbial Sensitivity Tests , Multivariate Analysis , Polymerase Chain Reaction , Prospective Studies , Risk , Tertiary Care Centers , Thailand/epidemiology , Time Factors , Treatment Outcome , Tuberculosis/drug therapy , Tuberculosis/microbiology , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/microbiologyABSTRACT
UNLABELLED: The sophisticated and expensive treatment modalities of persistent pulmonary hypertension of the newborn (PPHN), such as nitric oxide, are limited in developing countries. Alternative (less expensive) treatments are being sought and bosentan, an oral dual endothelin-1 receptor antagonist, may be an option for the treatment of PPHN. We report our experience of using bosentan in a neonate with severe PPHN. CONCLUSION: Bosentan may be a useful adjuvant therapy in neonates with PPHN, providing significant improvement in oxygenation, and thus may be particularly useful in the treatment of PPHN in countries with limited resources.
