title: Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians.
abstract: WHO estimated that of 9.4 million cases of tuberculosis (TB) worldwide in 2008, 440,000 (3.6%) had multidrug-resistant (MDR)-TB. Childhood TB is estimated at 10-15% of the total burden, but little is known about the burden of MDR-TB in children. Children in close contact with MDR-TB cases are likely to become infected with the same resistant strains and are vulnerable to develop disease. Although MDR-TB is a microbiological diagnosis, children should be treated empirically according to the drug susceptibility result of the likely source case, as often cultures cannot be obtained from the child. MDR-TB treatment in children is guided by the same principles, using the same second-line drugs as in adults, with careful monitoring for adverse effects. Co-infection with HIV poses particular challenges and requires early initiation of antiretroviral therapy. Preventive therapy for high-risk MDR-TB contacts is necessary, but no consensus guidance exists on how best to manage these cases. Pragmatic and effective Infection control measures are essential to limit the spread of MDR-TB.
authors.affiliation: Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, and Tygerberg Children's Hospital, Cape Town, South Africa. hss@sun.ac.za
authors.forename: H Simon
authors.initials: HS
authors.lastname: Schaaf
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Marais
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D006801:Humans; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*
chemical_list: D000995:Antitubercular Agents