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Thorax. High treatment success in children treated for multidrug-resistant tuberculosis: an observational cohort study
[Source: Thorax, full page: (LINK). Abstract, edited.]
<CITE><ABBR>Thorax</ABBR> doi:10.1136/thoraxjnl-2013-203900 </CITE>
<CITE></CITE>
<CITE></CITE>Tuberculosis / Original article
High treatment success in children treated for multidrug-resistant tuberculosis: an observational cohort study
James A Seddon 1,2,3, Anneke C Hesseling 1, Peter Godfrey-Faussett 2, H Simon Schaaf 1,4
<SUP>1</SUP>Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa <SUP>2</SUP>Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK <SUP>3</SUP>Department of Paediatric Infectious Diseases, Imperial College London, London, UK <SUP>4</SUP>Tygerberg Children's Hospital, Tygerberg, South Africa
Correspondence to Dr James Seddon, Department of Paediatric Infectious Diseases, Imperial College London, Norfolk Place, London W2 1NY, UK; james.seddon@imperial.ac.uk
Received 19 May 2013 - Revised 31 July 2013 - Accepted 31 August 2013 - Published Online First 24 September 2013
Abstract
Background
Few studies have described the management of multidrug-resistant (MDR) tuberculosis (TB) in children and evidence-based guidance on management is lacking. We describe the presentation, treatment and outcome in children treated for severe and non-severe MDR-TB in Cape Town, South Africa.
Methods
We conducted an observational cohort study of all children (<15 years) treated for MDR-TB if routinely initiated on treatment between January 2009 and December 2010. Treatment was based on local standard of care, based on international guidelines. Data were collected through family interviews and folder review. Standardised definitions were used for diagnosis, severity of disease, adverse events and outcome.
Results
Of 149 children started on MDR-TB treatment, the median age was 36 months (IQR 16?66), 32 (22%; of 146 tested) had HIV infection and 59 (40%) had a confirmed diagnosis. Ninety-four (66%) children were treated with an injectable drug and the median total duration of treatment was 13 months (IQR 11?18). Thirty-six (24%) children were cured, 101 (68%) probably cured, 1 (1%) was transferred out, 8 (5%) were lost to follow-up and 3 (2%) died. Children with severe disease were older (54 months (IQR 18?142) vs 31.5 months (IQR 17.5?53.5); p=0.012), more commonly had HIV infection (OR 6.25; 95% CI 2.50 to 15.6; p<0.001) and were more likely to die (p=0.008).
Discussion
A confirmed diagnosis of MDR-TB is not possible in all cases but this should not impede the treatment of MDR-TB in children. More than 90% of children with MDR-TB can be successfully treated. Non-severe disease could be successfully treated with reduced treatment duration.
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<CITE><ABBR>Thorax</ABBR> doi:10.1136/thoraxjnl-2013-203900 </CITE>
<CITE></CITE>
<CITE></CITE>Tuberculosis / Original article
High treatment success in children treated for multidrug-resistant tuberculosis: an observational cohort study
James A Seddon 1,2,3, Anneke C Hesseling 1, Peter Godfrey-Faussett 2, H Simon Schaaf 1,4
<SUP>1</SUP>Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, South Africa <SUP>2</SUP>Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK <SUP>3</SUP>Department of Paediatric Infectious Diseases, Imperial College London, London, UK <SUP>4</SUP>Tygerberg Children's Hospital, Tygerberg, South Africa
Correspondence to Dr James Seddon, Department of Paediatric Infectious Diseases, Imperial College London, Norfolk Place, London W2 1NY, UK; james.seddon@imperial.ac.uk
Received 19 May 2013 - Revised 31 July 2013 - Accepted 31 August 2013 - Published Online First 24 September 2013
Abstract
Background
Few studies have described the management of multidrug-resistant (MDR) tuberculosis (TB) in children and evidence-based guidance on management is lacking. We describe the presentation, treatment and outcome in children treated for severe and non-severe MDR-TB in Cape Town, South Africa.
Methods
We conducted an observational cohort study of all children (<15 years) treated for MDR-TB if routinely initiated on treatment between January 2009 and December 2010. Treatment was based on local standard of care, based on international guidelines. Data were collected through family interviews and folder review. Standardised definitions were used for diagnosis, severity of disease, adverse events and outcome.
Results
Of 149 children started on MDR-TB treatment, the median age was 36 months (IQR 16?66), 32 (22%; of 146 tested) had HIV infection and 59 (40%) had a confirmed diagnosis. Ninety-four (66%) children were treated with an injectable drug and the median total duration of treatment was 13 months (IQR 11?18). Thirty-six (24%) children were cured, 101 (68%) probably cured, 1 (1%) was transferred out, 8 (5%) were lost to follow-up and 3 (2%) died. Children with severe disease were older (54 months (IQR 18?142) vs 31.5 months (IQR 17.5?53.5); p=0.012), more commonly had HIV infection (OR 6.25; 95% CI 2.50 to 15.6; p<0.001) and were more likely to die (p=0.008).
Discussion
A confirmed diagnosis of MDR-TB is not possible in all cases but this should not impede the treatment of MDR-TB in children. More than 90% of children with MDR-TB can be successfully treated. Non-severe disease could be successfully treated with reduced treatment duration.
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