We read with interest the review article by Khurana, et al. [1],
published recently in Indian Pediatrics. We would like to
highlight the recent changes in the management of pediatric tuberculosis
(TB) based on Revised National Tuberculosis Control Programme (RNTCP)
Updated Pediatric TB Guidelines 2019 and WHO consolidated guidelines on
drug resistant tuberculosis treatment 2019 [2].
Changes in diagnostic algorithm: As tuberculosis
is a paucibacillary disease in children, performance of smear microscopy
and culture is poor. Hence, Cartridge based nucleic acid assay (CBNAAT)
is the preferred investi-gation of choice over smear examination (and
best yield when ordered based on positive chest X-ray). If CBNAAT
is not available, smear microscopy is to be performed.
Newer classification of drugs: The drugs for
multidrug resistant tuberculosis (MDR-TB) have been recategrized into
three groups. Thus, Box 2 of the review article needs revision.
Changes in treatment approach for previously treated
cases: Previously treated TB includes (recurrence, treatment after
loss to follow-up and treatment failure). All these children need to be
evaluated for drug-resistant TB. In case they are found to be drug
sensitive, they shall be started on the same regimen as for a newly
diagnosed case. Category II has been now withdrawn from RNTCP.
Streptomycin is now considered as second-line medicine, and should be
used only as a substitute for Amikacin, when it is not available or
confirmed resistance to it.