clinical evaluation and known exposure to a source patient with DR TB. Cure rates in children exceeding 80 percent have been documented around the world using regimens that are tailored to the child’s susceptibility profile or to that of the source case, even in children who are coinfected with HIV.
Becerra and Gao listed several potential action items and resource needs that could help expose and address the “silent epidemic” of DR TB in children:
• Children with DR TB can be a key indicator to help guide a large-scale policy response. The identification of children with DR TB allows for the monitoring of gaps, needed drugs, and whether programs are accessing the support they need to deliver care to children.
• Adoption of 1-year targets for the treatment of DR TB in children at the global, country, and institutional levels could help improve treatment rates. Targets could be defined either in terms of absolute numbers or as a percentage of the treatment for drug-resistant patients. To complement these efforts, institutions and countries could improve reporting of how many children are being treated and how many are waiting for treatment.
• Tests diagnosing TB and identifying drug resistance that perform well in children need to be developed.
• Treatment regimens need to be optimized for pediatric disease. This can be done using both prospective and retrospective approaches. A wealth of clinical information is available from around the world, including information on children, but the right partners and analytic tools are needed to deal with retrospective data. Funding for this research also is needed.
• Drugs in child-friendly formulations are needed. In addition, more needs to be known about the pharmacokinetics and pharmacodynamics of old and new drugs to optimize dosing in children.
• Ongoing exchange needs to be supported and promoted among clinicians and researchers to share best practices and accelerate learning in real time; exchange needs to occur across countries and needs to overcome language barriers.