title: A bitter pill to swallow: the need for better medications for drug-resistant tuberculosis in children.
abstract: The large and growing access gap between the number of children who become sick with drug-resistant tuberculosis (DR-TB) and those who are treated for the disease each year represents a significant health systems failure. While there are multiple reasons why children with DR-TB are not diagnosed and treated, a serious challenge is the medications used to treat the disease. This paper presents three child DR-TB cases who were treated incorrectly; the cases are used to illustrate some of the problems with existing second-line medications. Challenges, including the perception that the drugs are more dangerous than the disease, lack of proper dosing recommendations and formulations, and the high cost of current treatment, all contribute to a perverse situation in which the most vulnerable pediatric patients are provided with a lower standard of care. This situation can be reversed with novel partnerships and training models, pharmacokinetic studies of the relevant drugs, increased collaboration, and dedicated funding, grounded in a rights-based approach to DR-TB in children.
authors.affiliation: Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, USA.
authors.forename: J
authors.initials: J
authors.lastname: Furin
authors.affiliation: University Research Corporation, Mbabne, Swaziland.
authors.forename: A
authors.initials: A
authors.lastname: Mafukidze
authors.affiliation: Access Campaign, Médecins Sans Frontières (MSF), Geneva, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Brigden
authors.affiliation: Manson Unit, MSF, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: du Cros
authors.affiliation: Baylor International Paediatric AIDS Initiative, Mbabane, Swaziland.
authors.forename: R
authors.initials: R
authors.lastname: Golin
authors.affiliation: TB Research Unit, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: E
authors.initials: E
authors.lastname: Harausz
authors.affiliation: Imperial College, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Seddon
authors.affiliation: Global TB Childhood Programme, Baylor College of Medicine, Swaziland.
authors.forename: P
authors.initials: P
authors.lastname: Ustero
authors.affiliation: Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa.
authors.forename: A J
authors.initials: AJ
authors.lastname: Garcia-Prats
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents