title: Treating children for drug-resistant tuberculosis in Tajikistan with Group 5 medications.
abstract: BACKGROUND
  Management of extensively drug-resistant tuberculosis (XDR-TB) and pre-XDR-TB is challenging, as effective drugs are lacking. Group 5 anti-tuberculosis drugs have an unclear role in the treatment of drug-resistant TB, and in children the efficacy, safety and effects of long-term use are not well described. We present clinical outcomes and adverse effects of a cohort of children with XDR-TB or pre-XDR-TB treated with Group 5 drugs in Tajikistan.
  
  
  METHODS
  We conducted a retrospective analysis of eight children treated with one or more of the Group 5 drugs available under the Tajikistan National TB Programme-linezolid, amoxicillin-clavulanate, clofazimine and clarithromycin-given in combination with first- and second-line drugs. Time to sputum culture conversion, clinical outcomes and adverse effects were evaluated.
  
  
  RESULTS
  Two children were cured, one completed treatment, four achieved favourable interim outcomes and one died. Adverse effects attributable to linezolid that required drug cessation occurred in one child; adverse effects of the other Group 5 drugs were insignificant or absent, requiring no regimen changes.
  
  
  CONCLUSIONS
  Group 5 drugs can contribute to effective regimens in children with XDR and pre-XDR-TB. With proper monitoring and aggressive management of adverse effects, their safety profile might be acceptable, even in long-term use.
authors.affiliation: Médecins Sans Frontières (MSF), Dushanbe, Tajikistan.
authors.forename: A
authors.initials: A
authors.lastname: Swaminathan
authors.affiliation: Manson Unit, MSF, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: du Cros
authors.affiliation: Manson Unit, MSF, London, UK; Imperial College London, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Seddon
authors.affiliation: Médecins Sans Frontières (MSF), Dushanbe, Tajikistan.
authors.forename: S
authors.initials: S
authors.lastname: Quinnell
authors.affiliation: National Tuberculosis Programme, Ministry of Health and Social Protection of the Republic of Tajikistan, Dushanbe, Tajikistan.
authors.forename: O I
authors.initials: OI
authors.lastname: Bobokhojaev
authors.affiliation: Médecins Sans Frontières (MSF), Dushanbe, Tajikistan.
authors.forename: Z
authors.initials: Z
authors.lastname: Dusmatova
authors.affiliation: Manson Unit, MSF, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Achar
mesh_terms: D000293:Adolescent; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use; D002991:Clofazimine / Q000627:therapeutic use; D004338:Drug Combinations; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069349:Linezolid / Q000627:therapeutic use; D008297:Male; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D013620:Tajikistan; D016896:Treatment Outcome
chemical_list: D000995:Antitubercular Agents; D004338:Drug Combinations; D019980:Amoxicillin-Potassium Clavulanate Combination; D002991:Clofazimine; D017291:Clarithromycin; D000069349:Linezolid