Principles for Management of MDR/RR-TB in Children

The principles for the treatment and monitoring of Multidrug-resistant (MDR)/ Rifampicin-resistant TB (RR-TB) in children are quite similar to adults and use the same second-line drugs. 

Principles 

• Always treat in consultation with an expert, preferably a paediatrician available/ linked to the Drug-resistant TB Centre (DR-TBC).
• Include at least 4-5 effective medicines from groups A and B to which the Mycobacterium tuberculosis strain is known or likely to be susceptible.
• Do not add a single drug to a failing regimen to avoid amplification of resistance.
• Strict monitoring of treatment by clinical examination, radiology and culture response to be undertaken by paediatrician/ expert available.

Drug Formulations for Management of DR-TB in Children

• Child-friendly (dispersible and palatable) formulations of the medications should be used whenever available.
• Bedaquiline (Bdq) tablets suspended in water should be used to treat Drug-resistant TB (DR-TB) in children until a child-friendly formulation becomes available.

​Regimen

• Children under the age group 5 to 18 years and weighing at least 15 kg, are eligible for both shorter or longer oral MDR/ RR-TB regimens.​
• Children below 5 years are not excluded from the short course but instead get a short course injectable till further evidence on the use of Bdq is available.
• The dosages for drugs used in various DR-TB regimens by weight bands for paediatric DR-TB patients are used as recommended in the WHO Consolidated Guidelines for TB.

Resources
 

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, 2021.
• WHO Consolidated Guidelines on Tuberculosis: Module 4 – Treatment: Drug Resistant TB Treatment, 2020.

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