Written By: Debjani Arora | Updated : August 23, 2018 4:00 PM IST
Image credits by: Steps are taken by forthcoming first-ever UN High Level Meeting (UNHLM) to #endTB. © Shutterstock
Tuberculosis is a bacterial infection that is contagious in nature. This bacterium knows no bias and can invade the immune system of the rich and poor, the young and the old, the wise and otherwise alike. However, it is treatable and curable too. Antibiotics are prescribed to treat this infection and help one recover from its wrath. However, at times, the prescribed medications that are used to treat a tuberculosis infection can do little to kill the bacteria, when this happens the condition is usually termed as drug-resistant tuberculosis where the infection fails to respond to medication. If it fails to respond to two or more drugs it is termed as multi-drug resistant tuberculosis. This can happen to both children and adults. In children, the treatment for MDR-TB becomes a challenge for doctors as lack of child-friendly drug formulations weakens their immune system further.
However, for adults there is not much difference when it comes to treatment as the drugs used are the same. The WHO has published guidelines for the approach to diagnose and treat DR-TB, based on experience in adults and children. However, in both cases, the grade of dosages for all recommendations is low, during the initial days of treatment.
Diagnosis and treatment
According to WHO, when a drug-resistant TB is suspected (when a person doesn't respond well to the first line of treatment) every effort should be made to confirm the diagnosis by obtaining specimens for culture and drug susceptibility testing (DST). The specimen obtained is usually sputum and chest x-rays are done to ascertain the damage. Rapid DST of isoniazid and rifampicin or of rifampicin alone is recommended over conventional testing or no testing at the time of diagnosis. WHO endorses molecular tests that provide evidence of drug resistance within hours to 1-2 days of specimen testing. This makes planning the treatment easier. In all cases of confirmed MDR-TB, you might be put on second-line of drugs to exclude chances of suffering from XDR-TB.
The line of treatment you can expect
Treatment regimens for children with MDR-TB follow the same principles as that of adults. Your physician may include a minimum of four to six drugs in the regimen, based on the prognosis and condition.
Group 1 first-line oral drugs: A treatment for both adults and kids start with first line oral drugs if they don't show any kind of drug resistance. These drugs are prescribed by the physician who would urge you to stay on track with the pills for the duration of therapy without missing the doses. Missing doses can worsen the condition.
Group 2 injectable agent based on DST results and treatment history: Now, if any child or adult shows drug resistance after specimen testing then injectable medications might become a necessity and could be prescribed for a minimum of 4 to 6 months after a proper diagnosis along with the oral drugs.
Group 3 fluoroquinolone based on DST results and treatment history: This line of the drug is usually prescribed if the patient, both children and adults do not show signs of faster recovery and the strain of bacteria is still fund in their sputum or chest x-rays. This line of treatment can induce faster recovery in MDR-TB.
Group 4 second-line oral drugs: These drugs could be added to your schedule to fight MDR-TB along with the first 3 groups if a more strong approach is needed. Your doctor might decide about it after doing your follow-up tests.
Usually, a minimum of four drugs could be prescribed to combat MDR-TB.
Recommendations for children
![Tuberculosis drug]](https://st1.thehealthsite.com/wp-content/uploads/2014/03/tuberculosis-drug.jpg)
Very few second-line drugs are produced in paediatric formulations. This means that optimal dosing of second-line drugs is unknown and that tablets must be broken or cut, potentially leading to inaccurate dosages and blood concentrations that are sub-therapeutic or toxic. The taste of medications is often unpalatable and a number of the drugs can cause vomiting and diarrhoea. This may affect the amount of drug absorbed. Daily injectable drugs are usually given for the first few months of treatment and the pill burden can be vast.
The number of drugs needed to treat MDR-TB in children has not been prospectively evaluated. However, extensive pulmonary TB might be treated with a combination of four or more drugs.
Image source: Shutterstock
Reference: Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children. 2nd edition. World Health Organisation, 2014.
Disclaimer: The content on TheHealthSite.com is only for informational purposes. It is not at all professional medical advice. Always consult your doctor or a healthcare specialist for any questions regarding your health or a medical condition.
