Abstract
Introduction: The incidence of drug-resistant tuberculosis (TB) is rapidly increasing worldwide. Children in high TB burden countries are rapidly being reported to be affected by multidrug-resistant TB (resistant to isoniazid and rifampicin). The aim of this study is to evaluate the pattern of drug sensitivity among children suffering with TB. Methods: Known cases of pulmonary TB, with sputum smear positive even after two months of compliance to 1st line anti-tuberculous therapy were included after gaining informed consent. Specimens used for drug sensitivity analysis were either sputum or bronchoalveolar lavage. Patient age, gender, history of TB contact, and duration of treatment were also recorded. Data was entered and analyzed using SPSS v.22. Results: There were 32 male (64%) and 18 female (36%) children in the study. Their mean age was 12.84 ± 2.54 years. History of household TB contact was positive in 29 (58%) children. Among 1st line anti-tuberculous therapy, ethambutol and streptomycin were most sensitive (n=44; 88%). Rifampin was least sensitive (n=17; 34%). There were 32 (64%) children with multidrug-resistant tuberculosis (MDR-TB). A positive history of household TB contact (either resistant or non-resistant) was seen to have a statistically significant impact on incidence of MDR-TB (p value=0.03) Conclusion: Pediatric drug-resistant TB is a rising concern. Awareness programs on national and international levels are needed to educate the general population regarding the importance of preventing TB household contact, especially amongst children.
Highlights
The incidence of drug-resistant tuberculosis (TB) is rapidly increasing worldwide
Globally, there are approximately 67 million children suffering from Mycobacterium tuberculosis (MTB) infection
Children who had become negative for MTB on sputum smear or culture with 1st line anti-tuberculous therapy (ATT), indicating response to these drugs, were not included
Summary
The incidence of drug-resistant tuberculosis (TB) is rapidly increasing worldwide. History of household TB contact was positive in 29 (58%) children. A positive history of household TB contact (either resistant or nonresistant) was seen to have a statistically significant impact on incidence of MDR-TB (p value=0.03) Conclusion: Pediatric drug-resistant TB is a rising concern. In 2014 alone, an estimated 850,000 children developed pulmonary tuberculosis with 25,000 multidrug-resistant cases[1]. Adding to the current poor trajectory there have been reports of extensive drug resistance in paediatric pulmonary tuberculosis, with almost 100,000 such cases reported[1]. In TB patients, drug resistance results from spontaneous genetic mutations in the MTB genome. In children the more common reasons of drug resistance are transmission of a resistant bacillus and previous treatment with anti-tuberculous therapy (ATT). Other factors that predispose to drug-resistant TB include inappropriate drug regimens, monotherapy, and drug non-adherence[3]
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