Treatment failure

A person with treatment failure is defined as one whose treatment regimen needed to be terminated or permanently changed to a new regimen or treatment strategy. Reasons for such a change include no clinical or bacteriological response, adverse drug reactions, and evidence of resistance to medicines in the regimen (108).

The possibility of treatment failure should be considered in a child or adolescent who is receiving TB treatment and (72):

  • has no symptom resolution or has worsening symptoms;
  • shows continued weight loss;
  • is smear-positive at 2-months’ follow-up (for children and adolescent with bacteriological confirmation at diagnosis).

Box 5.12 summarizes important questions to ask if a child or adolescent is not responding to or is deteriorating on TB treatment.

Box 5.12 Questions to ask in children and adolescents not responding to or deteriorating on TB treatment

Poor adherence is a common cause of treatment failure. Treatment failure also suggests the possibility of RR/MDR-TB and needs careful assessment with additional diagnostic evaluations. It may also be more common in children and adolescents living with HIV (79).

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