Multi Drug Resistant (MDR) Tuberculosis is defined as TB caused by an isolate that shows resistance to at least isoniazid and rifampicin. Treatment of children with Multi Drug Resistant (MDR) Tuberculosis is quite complicated. Inappropriate treatment can cause extensive damage to the lungs or other body organs involved and can lead to mortality. Multi Drug Resistant (MDR) Tuberculosis should be managed by pediatricians with experience in the management of tuberculosis especially Multi Drug Resistant (MDR) Tuberculosis.
What are the medicines used in the treatment of MultiDrug Resistant (MDR) Tuberculosis in children?
The most important medicines used for treatment of children with Multi Drug Resistant (MDR) Tuberculosis are: Levofloxacin or moxifloxacin, bedaquiline, linezolid, clofazimine and cycloserine. Other medicines which might be required on a case to case basis are amikacin, ethambutol, imipenem or meropenem, para-aminosalicylic acid, Prothionamide, pyrazinamide and delamanid.
What drug regimens are used for treatment of MultiDrug Resistant (MDR) Tuberculosis in children?
The shorter drug regimen for MultiDrug Resistant (MDR) Tuberculosis uses a combination of bedaquline, moxifloxacin, pyrazinamide, ethambutol, high dose isoniazid, ethionamide and clofazimine. The longer regimen for MultiDrug Resistant (MDR) Tuberculosis consists of a combination of bedaquline, levofloxacin, linezolid cycloserine and clofazimine.
What is the duration of treatment for MultiDrug Resistant (MDR) Tuberculosis in children?
The duration of treatment depends on the many factors like site of involvement of TB (lungs, brain, lymph nodes etc), extent of disease, previous treatment received and most importantly the results of various tests like TB cultures with drug sensitivity. The drug sensitivity would indicate which medicines would work and which would not.
There are shorter duration treatments used in children with limited disease; the duration being 9-12 months. In children with extensive disease the duration of treatment is 18-24 months.
What are the problems associated with Multi Drug Resistant Tuberculosis or MDR-TB?
Multi Drug Resistant Tuberculosis or MDR-TB is much more difficult to treat compared to drug sensitive tuberculosis. The medicines used for treatment of MultiDrug Resistant Tuberculosis or MDR-TB are different compared to drug sensitive TB, they are less effective, take a longer time to act, the bacteria takes longer time to clear and there are many side effects of the medicines used.
In addition the patient with Multi Drug Resistant Tuberculosis or MDR-TB remains infectious for a longer time increasing the risk of spreading the infections amongst contacts. Multi Drug Resistant Tuberculosis or MDR-TB also appears in association with HIV infection or AIDS, which further compromises the immune system.
