Childhood Drug-Resistant Tuberculosis Epidemiology and Treatment
Summary
The global burden of drug-resistant tuberculosis in children is increasingly recognised as a critical public health challenge. Each year tens of thousands of children develop tuberculosis strains resistant to first-line agents, yet accurate incidence and mortality estimates remain elusive. Diagnosis in paediatric populations is hampered by paucibacillary disease, difficulties in obtaining suitable specimens and variable sensitivity of existing tests. Under-reporting is particularly severe in high-burden settings where surveillance systems lack age-disaggregated data. Key risk factors include household exposure to adults with resistant disease, HIV co-infection and malnutrition. Treatment regimens for drug-resistant strains require prolonged courses of second-line drugs such as fluoroquinolones, injectable agents and newer compounds including bedaquiline and delamanid. Paediatric dosing recommendations have traditionally been extrapolated from adult data, but pharmacokinetic variability poses challenges for achieving therapeutic exposures without undue toxicity. Preventive strategies, including isoniazid preventive therapy and molecular screening of household contacts, are under-utilised despite evidence of efficacy in averting disease progression. Recent guideline revisions advocate simplified all-oral regimens, shorter treatment durations and weight-band dosing, but implementation is uneven owing to limited paediatric formulations and resource constraints. Strengthening care pathways through decentralised management, improved paediatric drug formulations and integration with HIV and nutrition services is essential to reduce morbidity and mortality in this vulnerable population.
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Childhood Drug-Resistant Tuberculosis Epidemiology and Treatment publication trend
The graph below shows the total number of articles in childhood drug-resistant tuberculosis epidemiology and treatment across all publications each year (not limited to Nature Index journals).
Technical terms
Multidrug-resistant tuberculosis (MDR-TB): Infection by Mycobacterium tuberculosis strains resistant at least to isoniazid and rifampicin, the two most potent first-line drugs.
Extensively drug-resistant tuberculosis (XDR-TB): MDR-TB that is also resistant to any fluoroquinolone and at least one of the three second-line injectable agents.
Pharmacokinetics: The study of how a drug is absorbed, distributed, metabolised and eliminated in the body, critical for determining safe and effective dosing.
Area under the concentration–time curve (AUC): A measure of overall drug exposure over time, used to compare paediatric and adult dosing efficacy.
Isoniazid preventive therapy (IPT): Administration of isoniazid to individuals with latent tuberculosis infection to prevent progression to active disease.
References
- Pharmacokinetics and Optimal Dosing of Levofloxacin in Children for Drug-Resistant Tuberculosis: An Individual Patient Data Meta-Analysis. Clinical Infectious Diseases (2024).
- Treatment and outcomes in children with multidrug-resistant tuberculosis: A systematic review and individual patient data meta-analysis. PLOS Medicine (2018).
- Drug-Resistant Tuberculosis Among Children: A Systematic Review and Meta-Analysis. Frontiers in Public Health (2021).
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