Abstract
Over the last 10 years, interest in pediatric tuberculosis (TB) has increased dramatically, together with increased funding and research. We have a better understanding of the burden of childhood TB as well as a better idea of how to diagnose it. Our appreciation of pathophysiology is improved and with it investigators are beginning to consider pediatric TB as a heterogeneous entity, with different types and severity of disease being treated in different ways. There have been advances in how to treat both TB infection and TB disease caused by both drug-susceptible as well as drug-resistant organisms. Two completely novel drugs, bedaquiline and delamanid, have been developed, in addition to the use of older drugs that have been re-purposed. New regimens are being evaluated that have the potential to shorten treatment. Many of these drugs and regimens have first been investigated in adults with children an afterthought, but increasingly children are being considered at the outset and, in some instances studies are only conducted in children where pediatric-specific issues exist.
Highlights
How do children get tuberculosis? If a child is exposed to an individual, usually an adult, with infectious pulmonary tuberculosis (TB) disease they are at risk of inhaling aerosolised Mycobacterium tuberculosis and becoming infected
How should we investigate a child who has been exposed to a drug-resistant TB source case? If a child has been exposed to an infectious source case with DR-TB they should be assessed for evidence of TB disease
A clinical trial is urgently needed to assess how to best manage children exposed to MDR-TB, these studies together suggest that providing preventive therapy may be effective in stopping the transition from infection to disease
Summary
How do children get tuberculosis? If a child is exposed to an individual, usually an adult, with infectious pulmonary tuberculosis (TB) disease they are at risk of inhaling aerosolised Mycobacterium tuberculosis and becoming infected. One group in Cape Town, South Africa, have been treating TBM in children with a short, intensive regimen for a number of years [47,48,49] This consists of high-dose isoniazid (1520 mg/kg), rifampicin (20 mg/kg), pyrazinamide (40 mg/ kg) and ethionamide (20 mg/kg) for 6 months. A clinical trial is urgently needed to assess how to best manage children exposed to MDR-TB, these studies together suggest that providing preventive therapy may be effective in stopping the transition from infection to disease. For adults it is recommended that the intensive phase (including the injectable agent) should last 8 months and the full duration of therapy should be no less than 20 months, the 2016 WHO guidelines recognise the fact that many children with non-severe disease have been successfully treated with shorter regimens and many with no injectable in the regimen.
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