Drug-Resistant Tuberculosis in Children: Causes, Challenges, and Treatment

Tuberculosis (TB) in children poses a significant health challenge, and when it becomes drug-resistant, the complexity of treatment increases manifold. Drug-resistant tuberculosis (DR-TB) occurs when Mycobacterium tuberculosis does not respond to the standard first-line anti-tuberculosis drugs, making it more difficult to treat. This section deals with the causes, symptoms, and treatment strategies for DR-TB in children.

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What is Drug-Resistant Tuberculosis?

Drug-resistant tuberculosis occurs when the TB bacteria develop resistance to one or more anti-tuberculosis drugs. The most common forms include:

Multidrug-Resistant TB (MDR-TB): Resistant to isoniazid and rifampicin, the two most effective first-line drugs.
Extensively Drug-Resistant TB (XDR-TB): MDR-TB with additional resistance to fluoroquinolones and at least one second-line injectable drug.

Causes of Drug-Resistant Tuberculosis

Incomplete Treatment: Interruptions in TB treatment or taking medications incorrectly.
Direct Transmission: Infection with already resistant TB strains from another person.
Improper Prescribing: Incorrect drug regimens or dosages.
Weakened Immune Systems: In children with malnutrition, HIV, or other immune-compromising conditions, TB bacteria can develop resistance more easily.

Symptoms of Drug-Resistant TB in Children

Symptoms of DR-TB are often similar to drug-sensitive TB but may persist or worsen despite treatment. Common symptoms includes:

Persistent cough
Fever and night sweats
Weight loss or failure to gain weight
Fatigue and weakness
Symptoms of specific organ involvement, such as swollen lymph nodes or abdominal pain, if extrapulmonary TB is present.

When should a Drug Resistance be considered?

Drug resistance should be considered in the following circumstances:

Poor response to first line therapy: Poor response to treatment in a patient taking drugs as per a correct regime
Treatment after lost to follow up (also called as Defaulter): child has already received TB medicines for at least one month and then has stopped treatment.
Recurrent TB (Relapse): Child who been detected with TB in past and now has got a recurrence.
Children in contact of MDR TB adult patients

Diagnosing Drug-Resistant Tuberculosis

Early and accurate diagnosis is essential for managing DR-TB. Diagnostic tools include:

GeneXpert MTB/RIF: Detects TB bacteria and resistance to rifampicin.
Line Probe Assay (LPA): Identifies resistance to first- and second-line drugs.
MGIT TB Culture and Drug Susceptibility Testing (DST): Confirms Tb bacteria and drug resistance patterns to various TB drugs.
GeneXpert XDR: Detects TB bacteria and resistance to many second line drugs.

Treatment of Drug-Resistant Tuberculosis in Children

The treatment of DR-TB is longer, more complex, and often involves medications with more side effects. Key aspects include:

Second-Line Drugs

MDR-TB is treated with a combination of second-line drugs, including fluoroquinolones, bedaquiline, and linezolid.
Treatment duration is typically 9–20 months, depending on the severity and drug resistance pattern.

Individualized Treatment Regimens

Regimens are tailored based on drug susceptibility test results to ensure effectiveness.

Supportive Care

Nutritional support and management of co-existing conditions, such as HIV or malnutrition, are crucial for successful outcomes.

Directly Observed Therapy (DOT)

Ensures adherence to the lengthy treatment regimen, reducing the risk of further resistance.

Challenges in Treating Drug-Resistant Tuberculosis in Children

Side Effects: Second-line drugs often cause side effects like nausea, hearing loss, and bone marrow suppression.
Lengthy Treatment: The prolonged duration of treatment affects adherence.
Stigma: Families may face social stigma, leading to delayed diagnosis and treatment.

Preventing Drug-Resistant Tuberculosis in Children

Ensure completion of the full course of TB treatment in all cases.
Screen close contacts of DR-TB patients for early detection.
Improve infection control in healthcare and community settings.
Encourage the use of BCG vaccination to protect against severe TB forms.

Drug-resistant tuberculosis in children is a serious condition requiring early diagnosis and meticulous treatment. With proper care and adherence to treatment protocols, many children can recover and lead healthy lives. If your child is suffering from tuberculosis do get in touch with a tuberculosis expert.
Conclusion

DRUG Resistant Tuberculosis