title: Clinical and programmatic considerations in the treatment of MDR-TB in children: a series of 16 patients from Lima, Peru.
abstract: METHODS
  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.
authors.affiliation: Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, USA. jmukherjee@pih.org
authors.forename: J S
authors.initials: JS
authors.lastname: Mukherjee
authors.forename: J K
authors.initials: JK
authors.lastname: Joseph
authors.forename: M L
authors.initials: ML
authors.lastname: Rich
authors.forename: S S
authors.initials: SS
authors.lastname: Shin
authors.forename: J J
authors.initials: JJ
authors.lastname: Furin
authors.forename: K J
authors.initials: KJ
authors.lastname: Seung
authors.forename: A
authors.initials: A
authors.lastname: Sloutsky
authors.forename: A R
authors.initials: AR
authors.lastname: Socci
authors.forename: C
authors.initials: C
authors.lastname: Vanderwarker
authors.forename: L
authors.initials: L
authors.lastname: Vasquez
authors.forename: E
authors.initials: E
authors.lastname: Palacios
authors.forename: D
authors.initials: D
authors.lastname: Guerra
authors.forename: F A
authors.initials: FA
authors.lastname: Viru
authors.forename: P
authors.initials: P
authors.lastname: Farmer
authors.forename: H E
authors.initials: HE
authors.lastname: Del Castillo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D023801:Directly Observed Therapy; D024901:Drug Resistance, Multiple, Bacterial; D004361:Drug Tolerance; D006801:Humans; D010568:Peru; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*