Monitoring the response to treatment in children and adolescents includes clinical, radiological and microbiological parameters. In children, microbiological monitoring of the response to treatment may be challenging for the same reasons as it being difficult to obtain a microbiological diagnosis. In children and adolescents with a bacteriologically confirmed diagnosis, however, it is important to monitor smear and culture conversion and confirm cure, as recommended by WHO. Once cultures have become negative or in children who have never had a bacteriologically confirmed diagnosis (i.e. clinically diagnosed cases), repeated respiratory sampling may not be useful if the child is showing a good clinical response.
Due to challenges with microbiological monitoring, careful monitoring of the clinical and microbiological response to treatment is important. The best indicators of a positive clinical response to treatment are improvement of clinical symptoms and weight gain. All children on treatment for MDR/RR-TB should have regular clinical follow-up with weight monitoring and assessment of growth and improvement in nutritional measures (WFA and other indicators). Radiographic abnormalities from TB may resolve slowly. Although steady improvement in radiographic findings is expected, some abnormalities may persist to the end of treatment.
Recurrence or worsening of symptoms, failure to gain weight or loss of weight are often the first signs that treatment is failing. The presence of these or worsening of radiographic abnormalities should prompt a careful assessment of adherence and the effectiveness of the treatment regimen. In such cases, follow-up specimens for mycobacterial culture and DST are required.