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Free Content Management of paediatric tuberculosis in leading UK centres: unveiling consensus and discrepancies

SETTING: Large specialist paediatric TB clinics in the UK.

OBJECTIVE: To evaluate clinical practice and compare with national and international guidelines.

DESIGN: A survey based on an electronic questionnaire on the management of latent tuberculous infection (LTBI) and tuberculosis (TB) disease was conducted in 13 specialist paediatric TB clinics. The consensus and discrepancies were evaluated by descriptive analysis.

RESULTS: Practice was reportedly different when choosing age limits for preventive treatment for TB contacts with initially negative tuberculin skin tests (TSTs), interpretation of TST results and use of interferon-gamma release assays (IGRAs) in the context of LTBI. In relation to management of children with TB disease, practices varied for duration of treatment of osteoarticular TB, monitoring for ethambutol ocular toxicity and use of pyridoxine. There was limited experience with multidrug-resistant TB (MDR-TB), and over half of the clinics monitored MDR-TB contacts without giving preventive treatment.

CONCLUSIONS: The survey showed heterogeneity in several aspects of clinical care for children with TB. Available paediatric TB guidelines differ substantially, explaining the wide variations in management of childhood TB. Prospective paediatric studies are urgently required to inform and standardise clinical practice, especially in the context of evolving drug resistance.

Keywords: children; clinical practice; guidelines

Document Type: Research Article

Affiliations: 1: Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St Mary's Hospital, London 2: Department of Paediatrics, Heartlands Hospital, Birmingham 3: School of Medicine, University of Glasgow, Glasgow 4: Department of Paediatrics, Alder Hey Children's Hospital, Liverpool 5: Department of Paediatrics, North West London Hospitals NHS Trust, London 6: Department of Paediatric Infectious Diseases, University Hospital Southampton, Southampton 7: *Department of Paediatrics, Great North Children's Hospital, Newcastle upon Tyne 8: Department of Paediatric Infectious Diseases, Bristol Children's Hospital, Bristol 9: Department of Paediatric Infectious Diseases, St George's Hospital, London 10: Department of Paediatrics, Royal Manchester Children's Hospital, Manchester 11: Department of Paediatrics, The Royal London Hospital, London 12: Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London 13: Department of Paediatrics, Newham University Hospital, London 14: Academic Department of Paediatrics, Imperial College London, UK

Publication date: September 1, 2014

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