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Multidrug-resistant tuberculosis in UK children: presentation, management and outcome
13 auth. B. Williams, Shiva Ramroop, P. Shah, L. Anderson, Sreena Das, A. Riddell, S. Liebeschuetz, R. Basu Roy, M. O'Callaghan, K. Sloper, ... J. Bernatoniene, D. Shingadia, B. Kampmann
To the Editor: Multidrug-resistant tuberculosis (MDR-TB), defined as Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, is an increasing problem globally [1]. Children are not usually included in global surveys of MDR-TB in…
To the Editor: Multidrug-resistant tuberculosis (MDR-TB), defined as Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, is an increasing problem globally [1]. Children are not usually included in global surveys of MDR-TB incidence and prevalence [2] due to the diagnostic challenges of paucibacillary TB [3]. Data on the burden of MDR-TB in children are, therefore, lacking globally [1, 4, 5] and no published data from the UK exist. The current World Health Organization (WHO) [6] and National Institute for Clinical Excellence (NICE) [7] TB guidelines for the management of MDR-TB do not explicitly address paediatric disease. As a consequence, the complex management of this condition is left to individual clinicians' judgment. In general, childhood TB is paucibacillary, most cases are treated on clinical grounds without drug susceptibility testing [2], and correct and timely diagnosis of childhood MDR-TB is therefore challenging. There are limited data on the pharmacokinetics, dosing and safety of the many second-line drugs used to treat MDR-TB in children [5]. Our group is the first to review the management of a paediatric cohort with MDR-TB in the UK, and represents the largest available dataset from children with culture-confirmed MDR-TB from western …
4
3 2013