New and repurposed drugs for pediatric multidrug-resistant tuberculosis practice-based recommendations

It is estimated that 33,000 children develop multidrug-resistant tuberculosis (MDR-TB) each year. In spite of these numbers, children and adolescents have limited access to the new and repurposed MDR-TB drugs. There is also little clinical guidance for the use of these drugs and for the shorter MDR-TB regimen in the pediatric population. This is despite the fact that these drugs and regimens are associated with improved interim outcomes and acceptable safety profiles in adults. This review fills a gap in the pediatric MDR-TB literature by providing practice-based recommendations for the use of the new (delamanid and bedaquiline) and repurposed (linezolid and clofazimine) MDR-TB drugs and the new shorter MDR-TB regimen in children and adolescents

Encouraging treatment outcomes among children with extensively drug-resistant tuberculosis: a global systematic review and individual patient meta-analysis

Extensively drug-resistant (XDR) tuberculosis (TB) has extremely poor treatment outcomes in adults and very limited pediatric data are available. We report on the presentation, treatment and outcome of children (<15 years) with bacteriologically confirmed XDR-TB, from 11 countries managed between 1999 and 2013. Among the 37 children, the median age was 11 years, 32 (87%) children had pulmonary TB and 29 had a recorded HIV status with seven (24%) HIV-infected. Treatment duration was 7.0 months for the intensive, and 12.2 months for the continuation phase. Thirty (81%) children had favorable treatment outcomes. Four (11%) died, one (3%) failed treatment and 2 (5%) were lost to follow-up during treatment. We demonstrate a high proportion of favorable treatment outcomes with mortality markedly lower than in adults. Regimens and the duration of treatment varied considerably. Evaluation of new regimens in children is required