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Correspondence

Indian Pediatr 2019;56: 692

Updated Pediatric Tuberculosis Guidelines

 

Janani Sankar and K Dhanlakshmi

Department of Pediatric Medicine and Infectious Diseases, Kanchi Kamakoti CHILDS Trust Hospital,
Chennai, Tamil Nadu, India.
Email: [email protected]
 

  


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 Category II has been now withdrawn from RNTCP.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.

References

1. Khurana AK, Dhingra B. What is new in management of pediatric tuberculosis? Indian Pediatr. 2019;56:213-20.

2. World Health Organization: WHO Consolidated Guidelines on Drug-Resistant Tuberculosis Treatment. 2019. Available from: https://www.who.int/tb/publica tions/2019/consolidated-guidelines-drug-resistant-TB-treatment/en/. Accessed April 27, 2019.

 

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