Abstract
Anti-TB drugs for children: Aetiotropic therapy is used for the treatment of tuberculosis (TB) in children, as well as in adult patients. Anti-tuberculosis drugs (anti-TB drugs) are divided into 3 lines, taking into account drug sensitivity in Mycobacterium tuberculosis (MBT). First-line anti-TBdrugs (basic) are used to treat TB caused by drug-susceptible MBT. Second- and third-line (reserve) drugs are recommended for the treatment of MBT-induced multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, respectively.
 Stages and regimens to treat tuberculosis: Chemotherapy of tuberculosis in children is carried out in 2 stages (intensive treatment and continuation of treatment) and includes 5 regimens. Each regimen assumes a certain combination of anti-TB drugs, indicating the duration and frequency of their administration. The final chemotherapy regimen is chosen only according to the results of determining the drug sensitivity. To improve the TB epidemic among children, it is important to improve the regimens for the use of anti-TB drugs. The effectiveness of anti-tuberculosis pharmacotherapy is largely determined by the MBT sensitivity and the rational choice of the chemotherapy regimen. The wrong choice of a chemotherapy regimen or its violation threatens to reduce the effectiveness of pharmacotherapy and expand the spectrum of resistance of the pathogen. The development of fixed-dose combination anti-TB drugs and special dosage forms for children will improve the quality of chemotherapy and adherence to treatment. Pharmacoeconomic studies are needed to increase the effectiveness of drug pharmacotherapy for tuberculosis infection in children and to optimize the costs of its implementation.
Highlights
An estimated 10 million people (12% of them were children) worldwide fell ill with tuberculosis in 2019, according to The World Health Organization
The third-line, a reserve one, includes antibacterial drugs: Linezolid, Meropenem, Imipenem+Cilastatin, and Amoxicillin+Clavulanic acid. They are recommended for the treatment of extensively drug-resistant tuberculosis (XDR) of the pathogen (MBT resistance to Isoniazid, Rifampicin, any drug from the group of fluoroquinolones and one of the injectable second-line anti-tuberculosis antibiotics: Kanamycin and/or Amikacin and/or Capreomycin) and pre-XDR (resistance of Mycobacterium tuberculosis (MBT) to fluoroquinolone (Ofloxacin or Levofloxacin) or at least to one injectable second-line antibiotic (Capreomycin, Kanamycin or Amikacin), as well as in other cases when it is impossible to form a regimen of five effective drugs (Ministry of Healthcare of the Russian Federation 2014)
Anti-tuberculosis and antibacterial drugs are prescribed in maximum therapeutic doses (Table 1), taking into account the child’s age and body weight, with controlled continuous daily intake in accordance with the prescribed chemotherapy regimen (Ministry of Healthcare of the Russian Federation 2014; Russian Society of TB Clinicians 2016)
Summary
An estimated 10 million people (12% of them were children) worldwide fell ill with tuberculosis in 2019, according to The World Health Organization. The most effective method of treating tuberculosis patients is the use of aetiotropic chemotherapy with anti-TB drugs (World Health Organization 2021). This article presents an analysis of various regimens of chemotherapy for tuberculosis infection in children with the aim of optimizing them and increasing the effectiveness of the use of anti-tuberculosis drugs.
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