5.3. Treatment of multi-drug and rifampicin resistant TB in children

Around 25 000-32 000 children are estimated to develop MDR/RR-TB every year (75-77). In 2018, 3398 children (aged below 15 years) were started on second-line treatment for MDR/RR-TB. After increasing to 5586 in 2019, due to the impact of the COVID-19 pandemic, this number dropped back to 3234 in 2020, representing only 2.5% of the total number of persons with MDR/RR-TB initiated on treatment and only 10.1%-12.9% of the estimated number of children with incident MDR/RR-TB (78). Treatment outcomes reported in a systematic review and individual patient data meta-analysis conducted for the 2018 WHO DR-TB treatment guidelines, showed an overall successful treatment outcome of 78% in children treated for MDR-TB (75% of confirmed and 89% of clinically diagnosed children) (79). Appropriate treatment of children with MDR/RR-TB with a WHO recommended regimen is an important step in ensuring a successful treatment outcome, as well as preventing the acquisition of further drug resistance. Other measures to prevent drug resistance or limit its spread include treatment of drug-susceptible TB with a WHO recommended regimen (to avoid misuse or overuse of antibiotics), infection prevention and control, the use of WHO recommended molecular diagnostic tests and patient support. Recommendations on each of these areas are included in this consolidated guideline and on the WHO TB KSP The implementation and use of new molecular diagnostic tools, treatment decision algorithms and WHO recommended treatment regimens are vital components to ensure antimicrobial stewardship.

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