The World Health Organization (WHO) Regional Office for Europe has released an expert opinion on managing drug-resistant tuberculosis (DR-TB) in children and adolescents. The guidance is supported by a commentary in the Lancet.
The WHO expert group recommends that, to establish a diagnosis of tuberculosis disease, all efforts should be made to confirm tuberculosis bacteriologically, and to establish a drug-susceptibility profile. However, it says, a clinical diagnosis without bacteriological confirmation might commonly be needed in younger children, with a treatment regimen constructed based on the drug resistance pattern of the source case.
For the treatment of multidrug-resistant tuberculosis disease, the document recommends an all-oral regimen to avoid the use of regular injections. At least four effective drugs should be used at the beginning of treatment (composed of WHO group A and B drugs), with delamanid used if needed to construct an adequate regimen.
The guidance points out, currently, data are scarce on the use of bedaquiline in children under six years and on the use of delamanid in children younger than three years.
A 2019 modelling paper suggested that 14.1 per cent of TB-infected children in the European region are infected with multidrug-resistant strains, the highest proportion in the world.