In our patient we started empirically (based on adult XDR-TB source case’s isolate DST) at TB diagnosis with XDR-TB treatment including the following drugs: linezolid (10mg/kg/dose twice daily); clofazimine 50mg every second day (long half-life; dose 2-3mg/kg/day); PAS 200mg/kg/day; terizidone 15-20mg/kg/day; ethionamide 15-20mg/kg/day and capreomycin 20mg/kg IM daily. He also received prednisone 2mg/kg/day x 4 weeks tapered over a further 2 weeks for airway compression. He became culture-negative within a month of treatment and remained culture-negative since (18 months). Supplements included pyridoxine (vit B6).
Question 3: Which adverse effects are associated with second-line antituberculosis drugs and how should we screen for these?
Answer to Q3:
The common adverse effects of second-line antituberculosis drugs are shown in table 2:
Question 4: What about the new drugs – can we use them in children?
Answer to Q4
Two new drugs are available to adults with MDR-TB – bedaquiline (BDQ) and delamanid (DLM). These drugs are not registered for use in children and paediatric dose finding and toxicity studies have started only for DLM. DLM is available for children older than 6 years and >20kg through a compassionate use programme. The drug can be accessed in selected cases through the ERS/TB consilium or MSF programmes and final approval and supply from Otsuka, the manufacturers. MCC section 21 aproval also needs to be obtained. (17)
It is expected that the WHO will soon publish new guidelines on the management of adults and children with drug-resistant TB.
Question 5: What is the outcome of MDR and XDR-TB cases in children?
Answer to Q5
In children good theraputic outcomes are reported for both MDR and XDR-TB, the pooled estimate for treatment success was 81·67% (95% CI 72·54-90·80) in a recent systematic review.(17) Locally 90% of children with confirmed or suspected MDR-TB had a good outcome.(18) Drug-resistant TB meningitis and HIV infection was associated with increased mortality risk.(19)
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