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Dirk teaches Epidemiology mainly at postgraduate level, including teaching of specialist courses at advanced level.

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Martin and H. Stryhn eds : Veterinary epidemiological research. AVC Inc. Davies, P. Barnes and S. Gordon eds Clinical tuberculosis. Hodder Arnold, London, UK, Thoen, J. Steele and M. In these cases, months of therapy are recommended, and steroids in the first weeks of treatment also appear to be useful.

Table 2. Recommended first-line TB drugs for infants and children Since anti-TB drug production has focused on adults, most drugs are in the form of tablets which have some advantages in poor settings because they can be more easily transported and stored than liquid drugs.

However, infants and young children cannot swallow the tablets, and in these patients, galenic formulations must be prepared from the tablets.

Clinical Tuberculosis 4th Edition (Hardcover)

However, serious adverse events due to TB-drugs are rare in children. The major authorities in the United States recommend at least three drugs for initial therapy and a therapy duration of at least 9 months.

No data support this recommendation, however. MDR-TB therapy in children is complex because data regarding drug regimen, dosage, safety, and therapy duration are scant and extrapolated from adult data. Table 3. Recommended daily dosages of second-line TB drugs for infants and children Levofloxacin, moxifloxacin, or gatifloxacin may be useful in alternative regimens, but the potential role of a fluoroquinolone and the optimal treatment length have not been defined in children.

The authors demonstrated that all patients were cured one was lost at follow up and adverse events arthritis in two patients. The authors demonstrated that Overall, 5. It has been successfully used in adults, but data in children are scant. Rose et al. Non-HIV-infected patients did not experience adverse events, whereas all HIV-positive patients had adverse reactions, one of which was life-threatening. Four children were cured, and the others were still receiving therapy but improving. This suggests that regimens containing linezolid should also be considered for children with MDR-TB as long as the adverse events and high monetary costs are taken into account.

Conclusions Despite undeniable advances in identifying markers of definite, probable, or possible TB in recent years, many problems pediatricians face in managing TB remain unsolved. The most important difficulty lies in early diagnosis because treatment can completely cure the majority of cases where TB is suspected early. This is only with the assumption that the pathogens are fully drug susceptible and that patient compliance in treatment is ideal.

Achieving a cure is more difficult when treatment is delayed and when MDR pathogens are the cause of the disease. In these cases, prognosis is poor, particularly in children, because what can be done to treat MDR-TB is unclear. New studies of diagnostic tests and optimal treatment for children are urgently needed with the final goal of developing an effective anti-TB vaccine. In the meantime, an aggressive attitude must be adopted for both diagnosing and treating a child with suspected TB because TB can be a devastating disease for children.

References World Health Organization. Group of risk: WHO global tuberculosis report, World Health Organization. Guidance for national tuberculosis programmes on the management of tuberculosis in children, A research agenda for childhood tuberculosis improving the management of childhood tuberculosis within national tuberculosis programmes: research priorities based on a literature review, Shah I.

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Multidrug-resistant tuberculosis in children. Pediatr Infect Dis J ; Outcomes of comprehensive care for children empirically treated for multidrug-resistant tuberculosis in a setting of high HIV. PLoS One ; 7: e Isoniazid-resistant tuberculosis in children: a systematic review.


Pediatr Infect Dis J ; ee Pediatric and adolescent tuberculosis in the United States, Pediatrics ; e e Principles and practice of pediatric infectious diseases. Childhood tuberculosis in household contacts of newly diagnosed TB patients. PLoS One ; 7:e Diagnostic standards and classification of tuberculosis in adults and children. Pediatric tuberculosis: global overview and challenges. Clin Infect Dis ; 50 Suppl.

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Childhood tuberculosis and malnutrition. J Infect Dis ; Update in tuberculosis and nontuberculous mycobacterial disease Clinical tuberculosis. London: Hodder Arnold; Principi N, Esposito S. Diagnosis and therapy of tuberculous meningitis in children. Int J Tuberc Lung Dis. Outcome of tuberculosis patients registered during in major teaching hospitals of Peshawar.

Treatment outcome of tuberculosis patients registered at dots centre in a teaching hospital, south India. Int J Biol Med Res. Default during the intensive phase of treatment under DOTS programme. User Username Password Remember me. Font Size. Notifications View Subscribe.

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Full Text: PDF. The global plan to stop TB Clinical Tuberculosis. London: Hodder Arnold; Lenk S, Schroeder J.