Clinical and programmatic considerations in the treatment of MDR-TB in children: a series of 16 patients from Lima, Peru
Abstract:SETTING: Since 2000, the directly observed treatment, short-course (DOTS) strategy has been expanded in several countries to include treatment of multidrug-resistant tuberculosis (MDR-TB). This strategy is known as DOTS-Plus. Tuberculosis is a common cause of morbidity and mortality for children throughout the developing world. Children may also be infected with MDR-TB, yet most developing countries do not specifically address pediatric MDR-TB.
OBJECTIVE: To present the intermediate outcomes of the first 16 children enrolled in the Peruvian DOTS-Plus program and to demonstrate the tolerability of second-line anti-tuberculosis drugs.
RESULTS: Three children completed therapy and are cured, one child had bacteriologic and clinical failure after 12 months of therapy and died of respiratory insufficiency, and 12 have intermediate outcomes demonstrating favorable clinical, bacteriologic, and radiographic evidence of improvement after 9–19 months of therapy.
CONCLUSIONS: Of the 16 pediatric DOTS-Plus patients, 15 have tolerated therapy well and have had favorable clinical evolution. However, the diagnosis of pediatric MDR-TB is often extremely delayed due to reliance on the adult case definition and should be changed to prevent progressive, chronic illness in such children. Programmatic changes could facilitate earlier diagnosis and treatment of pediatric MDR-TB in Peru and in other DOTS-Plus programs.
Document Type: Regular Paper
Affiliations: 1: Division of Social Medicine and Health Inequalities, Brigham and WomenÕs Hospital, Boston, Massachusetts, USA; Socios En Salud, Lima, Peru; and Partners In Health, Boston, Massachusetts, USA 2: Division of Social Medicine and Health Inequalities, Brigham and WomenÕs Hospital, Boston, Massachusetts, USA; and Socios En Salud, Lima, Peru 3: Socios En Salud, Lima, Peru 4: Massachusetts State Laboratory Institute, Boston, Massachusetts, USA 5: Partners In Health, Boston, Massachusetts, USA 6: Instituto Nacional de Salud, Lima, Peru 7: Instituto de Salud del Niño, Lima, Peru
Publication date: July 1, 2003
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