Prevention is always better than cure especially in
the case of fatal diseases where the causative agents remain resistive to many
therapeutic drugs and the treatment is expensive.
Multidrug-resistant (MDR) Mycobacterium tuberculosis
with a high mortality rate is highly resistant to the standard drugs, rifampicin
and isoniazid, commonly used to treat the tuberculosis disease.
Exposure to MDR Mycobacterium tuberculosis makes the
children highly susceptible to infection, which progresses to disease within a
year in 90% of the cases. Infants with HIV infection are 20 times more
likely to acquire the tuberculosis disease.
This had prompted a team
of researchers to explore the available treatment options, methodologies and
guidelines to prevent the disease in children exposed to MDR tuberculosis
According to the review a prevention program is
more beneficial to children living under the same roof along with the person
infected with MDR tuberculosis disease.
The risk factors for contracting the disease is
estimated using tuberculin skin test (TST) and interferon-γ-release assays,
degree of exposure to the MDR Mycobacterium tuberculosis and drug
susceptibility of the bacterial strain.
The various International guidelines for prevention
of the disease in children who are in close proximity with patients inflicted
with the MDR tuberculosis disease are as follows.
• WHO recommends a daily dosage of 10 mg/kg of isoniazid
for 6 months for children below 5 years.
• The National Department of Health of South
Africa recommends a high-dosage (15 mg/kg) of isoniazid to children below 5
Of the various standard drugs used to treat
tuberculosis, Levofloxacin, a Fluoroquinolones and Ethionamide were found to
be potential drugs in a preventive treatment for Multidrug-resistant (MDR)
The authors also recommend a high dose of
isoniazid for a period of six months.
Parents and children need to be counseled about the
benefits of the preventive treatment and the need to follow the prescriptions
for the treatment to be successful.
HIV infection in children influences the initiation
of the preventive program for MDR tuberculosis. When the child is
simultaneously diagnosed with HIV infection and exposed to MDR tuberculosis
bacterium, it is suggested to begin the preventive treatment before the
initiation of the antiretroviral treatment.
Children infected with HIV often suffer from chronic
diarrhoea, which could affect the absorption of MDR Tuberculosis Preventive
treatment and HIV treatment.
The adverse effects of the drugs, other factors
influencing the treatment in children still remain unexplored.
With MDR tuberculosis disease rising at an alarming rate
the experts feel there is a critical need for in-depth research to assess the
effectives of the drugs and treatment in order to control the disease.
Reference: Management of children exposed to
multidrug-resistant Mycobacterium tuberculosis; The Lancet Infectious Diseases