Questions have been raised regarding category IV (i.e., DOTSPLUS MDR treatment) for Pediatric patients and there is no specific indication or benefit. Ours is a 200 bedded male TB hospital out of which 18 beds are kept apart in three separate rooms for MDR TB treatment and they are always full. We have, during the past 6 years, treated 4 pediatric patients successfully with second line drugs. DOTSPLUS by RNTCP has not been launched in West Bengal. We feel that MDR treatment should be given on a daily basis, to admitted patients only, to observe and tackle side effects of the drugs.

In Prof. P.M. Udani’s Text book of Pediatrics 1998: vol 2; p. 1084, the subcarinal lymph nodes, mediastinal lymph node tuberculosis is quite common in BCG vaccinated young children below 4 years of age. There is no such group in the AIIMS study. This type of tuberculosis is very difficult to diagnose by plain CXR alone. It is not possible to advise a CT scan as it is very expensive and the massive radiation will be harmful to the children. How should they be diagnosed in busy pediatric OPD? Here the scoring system advocated by P.M. Udani and Keith Edwards in Crofton’s Textbook of Clinical Tuberculosis should be of great help. In fact the very first point in the draft minutes of the workshop, under the heading Research Issues: Diagnosis: Development of and a multi-centric field evaluation of a Pediatric Scoring System. IAP guidelines in management of Pediatrics TB also has a scoring system. There may be over-diagnosis by the scoring system, but then, we will not get children coming back to us with severe and multi-system disease later. These are the children who attend OPD repeatedly for LRTI with negative CXR. We have had such cases.