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Paediatr Respir Rev. 2011 Mar;12(1):31-8. doi: 10.1016/j.prrv.2010.09.010. Epub 2010 Oct 14.

Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians.

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Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, and Tygerberg Children's Hospital, Cape Town, South Africa.


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.

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