Treatment outcomes in global systematic review and patient meta-analysis of children with extensively drug-resistant tuberculosis

Extensively drug-resistant tuberculosis (XDR TB) has extremely poor treatment outcomes in adults. Limited data are available for children. We report on clinical manifestations, treatment, and outcomes for 37 children (<15 years of age) with bacteriologically confirmed XDR TB in 11 countries. These patients were managed during 1999–2013. For the 37 children, median age was 11 years, 32 (87%) had pulmonary TB, and 29 had a recorded HIV status; 7 (24%) were infected with HIV. Median treatment duration was 7.0 months for the intensive phase and 12.2 months for the continuation phase. Thirty (81%) children had favorable treatment outcomes. Four (11%) died, 1 (3%) failed treatment, and 2 (5%) did not complete treatment. We found a high proportion of favorable treatment outcomes among children, with mortality rates markedly lower than for adults. Regimens and duration of treatment varied considerably. Evaluation of new regimens in children is required

Treatment and outcomes in children with multidrug-resistant tuberculosis: a systematic review and individual patient data meta-analysis.

CAPRISA, 2018.Abstract available in pdf

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

Comparing treatment success rates among children with MDR-TB infected with HIV, by timing of initiation of ART and by HIV status^a.

<p>Comparing treatment success rates among children with MDR-TB infected with HIV, by timing of initiation of ART and by HIV status<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002591#t004fn001" target="_blank">^a</a>.</p

Summary of treatment outcomes for children treated for MDR-TB.

<p>Summary of treatment outcomes for children treated for MDR-TB.</p

Tuberculosis case definitions and treatment outcome definitions.

<p>Tuberculosis case definitions and treatment outcome definitions.</p

Geographic distribution of patients.

<p>Locations of patients included in the individual patient data meta-analysis. The number indicates the number of participants included from each location.</p

Demographic and clinical characteristics among children with MDR-TB.

<p>Demographic and clinical characteristics among children with MDR-TB.</p

Summary of association of use of individual drugs with treatment success in children treated for confirmed MDR-TB (<i>n</i> = 641)^a^,^b^,^c^,^d.

<p>Summary of association of use of individual drugs with treatment success in children treated for confirmed MDR-TB (<i>n</i> = 641)<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002591#t006fn002" target="_blank">^a</a>^,<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002591#t006fn003" target="_blank">^b</a>^,<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002591#t006fn004" target="_blank">^c</a>^,<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002591#t006fn005" target="_blank">^d</a>.</p