title: Management of paediatric tuberculosis in leading UK centres: unveiling consensus and discrepancies.
abstract: METHODS
  Large specialist paediatric TB clinics in the UK.
  
  
  OBJECTIVE
  To evaluate clinical practice and compare with national and international guidelines.
  
  
  METHODS
  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.
authors.affiliation: Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Turkova
authors.affiliation: Department of Paediatrics, Heartlands Hospital, Birmingham, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Welch
authors.affiliation: School of Medicine, University of Glasgow, Glasgow, UK.
authors.forename: J Y
authors.initials: JY
authors.lastname: Paton
authors.affiliation: Department of Paediatrics, Alder Hey Children's Hospital, Liverpool, UK.
authors.forename: A
authors.initials: A
authors.lastname: Riordan
authors.affiliation: Department of Paediatrics, North West London Hospitals NHS Trust, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Williams
authors.affiliation: Department of Paediatric Infectious Diseases, University Hospital Southampton, Southampton, UK.
authors.forename: S V
authors.initials: SV
authors.lastname: Patel
authors.affiliation: Department of Paediatrics, Great North Children's Hospital, Newcastle upon Tyne, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Clark
authors.affiliation: Department of Paediatric Infectious Diseases, Bristol Children's Hospital, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Bernatoniene
authors.affiliation: Department of Paediatric Infectious Diseases, St George's Hospital, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Doerholt
authors.affiliation: Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK.
authors.forename: F
authors.initials: F
authors.lastname: Child
authors.affiliation: Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Walters
authors.affiliation: Department of Paediatrics, The Royal London Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Riddell
authors.affiliation: Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Shingadia
authors.affiliation: Department of Paediatrics, Newham University Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Liebeschuetz
authors.affiliation: Academic Department of Paediatrics, Imperial College London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Kampmann
mesh_terms: D000367:Age Factors; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D019983:Guideline Adherence / Q000592:standards; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000592:standards*; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059425:Interferon-gamma Release Tests / Q000592:standards; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires; D014374:Tuberculin Test / Q000592:standards; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy; D006113:United Kingdom; D014611:Vaccination
chemical_list: D000995:Antitubercular Agents; D001500:BCG Vaccine