New approaches to MDR/XDR TB chemotherapy in children and adolescents

Abstract

Actuality: There is lack of criteria to determine chemotherapy duration for children and adolescents with MDR/XDR TB. Aim: To develop new approaches to determine chemotherapy duration for children and adolescents with MDR/XDR TB; assess their effectiveness. Material and Methods: A cohort prospective study of 2017-18 included 18 patients aged 13-18 with MDR/XDR TB. Sputum examinations: three times at admission, monthly, DST, BACTEC MGIT-960. Dynamic computed tomography of the chest. The criteria for 12-month chemotherapy (6-month intensive phase with 5 drugs, 6-month continuation phase with 3 drugs): sputum conversion within 3 mo., cavity closure within 6 mo.. The criteria for chemotherapy of more than 12 mo.: sputum positivity for more than 3 mo., cavities – for more than 6 mo; surgery. Three-year follow-up after treatment completion. Results: MDR TB – 11, XDR TB – 8. Chemotherapy duration: 12 mo.– 9, more than year – 9. Shortened chemotherapy regimens: sputum conversion after 1 mo. – 8, 2 mo. – 1. Cavity closure: after 2 mo.– 3, 4 mo. – 2, 6 mo. – 4. Out of 9 cases on long-term chemotherapy sputum conversion was observed: after 1 mo. – 5, 3 mo. 2, 6 mo. – 1. Cavity closure: after 3 mo.– 1,6 m. – 1, 9 mo. – 2, without dynamics – 5. All 9 underwent surgery. The indications for surgery were: tuberculomas with decay – 8, fibrotic cavities –1. None developed relapse one year after treatment. Conclusions: We originally developed new scientifically justified criteria to determine chemotherapy duration for children and adolescents with MDR/XDR TB. Effectiveness of shortened chemotherapy regimens using fewer drugs was proved by absence of relapses.