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Shortened regimen for MDR-TB shows good results for children
Lesley Odendal, 2016-07-18 20:30:00
The use of the shortened
9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB), known
as the ‘Bangladesh regimen’ has shown to be successful in
83% of children and adolescents diagnosed with rifampicin-resistant (RR) TB.
The findings were presented at TB2016, a two-day
pre-meeting focused on the intersection between TB and HIV in the run up to the
21st International AIDS Conference in Durban, South Africa.
A second study presented at the meeting showed that
the antibiotic levofloxacin can be used to treat MDR-TB in children.
TB treatment for children remains a neglected area,
especially the diagnosis and treatment of drug-resistant TB (DR-TB) in children.
Challenges include a lack of research in TB in children, a lack of proper
dosing recommendations and formulations for children, a high cost of treatment
and a growing gap in access to treatment for children each year. Treatment
regimens for children also take up to two years, creating the need for research
in shorter regimens for children.
The shortened regimen for children study was conducted
during the inclusion period of an observational study conducted among adults in
nine African countries (Benin, Burkina Faso, Burundi, Cameroon, Côte d'Ivoire,
Niger, Central African Republic, Democratic Republic of Congo and Rwanda),
according to findings presented by Bassirou Souleymane from Action
“The regimen for treatment of multidrug-resistant
tuberculosis (MDR-TB) has been more than 80% effective in adults in different
settings, but its effectiveness and tolerance in children/adolescents is poorly
documented, in the context of few effective treatment options for children with
TB,” said Souleymane. The nine-month regimen had been shown to cure 82% of
cases in adults in an African study, presented at the 46th Union World Conference on Lung
Health in 2015.
Treatment was successful in 83% (56% cured, 27%
treatment completed), of the 48 children (less than 18 years of age) that were
started on treatment with the Bangladesh regimen. Twenty-three (48%) were girls, 5 (10%)
were aged 0-9 years, 9 were (19%) HIV-positive, and 30 had been (63%)
previously treated for TB.
There was no significant difference in successful
treatment outcomes by age (85% in 15 to 17 year-olds vs 80% in 0 to 9 and 10 to
15 year-old children, p < 0.05). The case fatality rate was higher among
children living with HIV (22% vs 5% in HIV-negative children), but treatment
success was similar according to HIV status among surviving children (100% vs
92%). Adverse events were reported in 62% of the children, none of which was
severe. Among 24 children assessed after treatment termination, 21 were alive
with confirmed treatment success, two had died and one had recurrence.
regimen is made up of four months of kanamycin, moxifloxacin, prothionamide,
isoniazid, clofazamine, ethambutol, and pyrazinamide (abbreviated as 4Km Mfx
Pto H Cfz E Z), followed by five months of moxifloxacin, clofazamine,
ethambutol and pyrazinamide (5 Mfx Cfz E Z).
“Treatment results of the Bangladesh regimen appear
excellent in children and adolescents, regardless of their HIV status, with
very limited side effects. This should encourage countries to adopt this
shortened MDR-TB treatment regimen for children,” said Souleymane.