Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 2022-2029 (doi:10.1542/10.1542/peds.2005-2235)
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Community-Based Therapy for Children With Multidrug-Resistant Tuberculosis

Peter C. Drobac, MDa,b,c, Joia S. Mukherjee, MD, MPHa,b,c,d, J. Keith Joseph, MDa,b,c, Carole Mitnick, ScDa,b,c,e, Jennifer J. Furin, MD, PhDa,b,c,f, Hernán del Castillo, MDb,c,g, Sonya S. Shin, MD, MPHa,b,c,f and Mercedes C. Becerra, ScDa,b,c,e

a Social Medicine and Health Inequalities
f Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts
b Partners in Health, Boston, Massachusetts
c Socios en Salud Sucursal Peru, Lima, Peru
d Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts
e Department of Social Medicine, Harvard Medical School, Boston, Massachusetts
g Instituto de Salud del Niño, Lima, Peru

OBJECTIVES. The goals were to describe the management of multidrug-resistant tuberculosis among children, to examine the tolerability of second-line antituberculosis agents among children, and to report the outcomes of children treated for multidrug-resistant tuberculosis in poor urban communities in Lima, Peru, a city with high tuberculosis prevalence.

METHODS. A retrospective analysis of data for 38 children <15 years of age with multidrug-resistant tuberculosis, either documented with drug sensitivity testing of the child's tuberculosis isolate or suspected on the basis of the presence of clinical symptoms for a child with a household contact with documented multidrug-resistant tuberculosis, was performed. All 38 children initiated a supervised individualized treatment regimen for multidrug-resistant tuberculosis between July 1999 and July 2003. Each child received 18 to 24 months of therapy with ≥5 first- or second-line drugs to which their Mycobacterium tuberculosis strain was presumed to be sensitive.

RESULTS. Forty-five percent of the children had malnutrition or anemia at the time of diagnosis, 29% had severe radiographic findings (defined as bilateral or cavitary disease), and 13% had extrapulmonary disease. Forty-five percent of the children were hospitalized initially because of the severity of illness. Adverse events were observed for 42% of the children, but no events required suspension of therapy for >5 days. Ninety-five percent of the children (36 of 38 children) achieved cures or probable cures, 1 child (2.5%) died, and 1 child (2.5%) defaulted from therapy.

CONCLUSIONS. Multidrug-resistant tuberculosis disease among children can be treated successfully in resource-poor settings. Treatment is well tolerated by children, and severe adverse events with second-line agents are rare.

Key Words: tuberculosis • multidrug resistance • international child health

Abbreviations: MDR-TB—multidrug-resistant tuberculosis • DST—drug susceptibility testing • ITR—individualized treatment regimen • NTP—National Tuberculosis Program • DOTS—directly observed therapy, short course

Accepted Nov 15, 2005.


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