Status: Funded - Closed
Optimizing treatment regimens for pediatric multidrug-resistant tuberculosis
Silvia Chiang, M.D.
Background: Globally, over 30,000 children fall sick with multidrug-resistant tuberculosis (MDR-TB) every year. Without robust pediatric data, clinical management follows international guidelines based on studies in adults and expert opinion. We aimed to identify baseline predictors of death, treatment failure, and treatment default among children with MDR-TB disease treated with second-line drugs.
Methods: This retrospective cohort study included all children ≤15 years old with confirmed and probable MDR-TB disease who began tailored regimens in Lima, Peru, between 2005 and 2009. Using logistic regression, we examined associations between patient and treatment characteristics and (1) death and treatment failure, and (2) treatment default.
Findings: 211 of 232 (90·9%) children had known treatment outcomes, of which 163 (77·2%) achieved cure or probable cure, 29 (13·7%) did not complete treatment, ten (4·7%) experienced treatment failure, and nine (4·3%) died. Independent baseline predictors of death or treatment failure were the presence of severe disease (aOR 4·96, 95% CI 1·61 to 15·26) and weight-for-age z-score ≤-1 (aOR 3·39, 95% CI 1·20 to 9·54). We did not identify any independent predictors of treatment default.
Interpretation: High cure rates can be achieved in children with MDR-TB using tailored regimens containing second-line drugs. However, children faced significantly higher risk of death or treatment failure if they had severe disease or were undernourished. These findings highlight the need for early interventions that can further improve outcomes for children with MDR-TB.
Drug Resistance, Tuberculosis, Retrospective Cohort, Treatment, Human
Texas Children's Hospital
United States, United States, Peru