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Drug-resistant tuberculosis and advances in the treatment of childhood tuberculosis

Over the last 10 years, interest in pediatric tuberculosis (TB) has increased dramatically, together with increased funding and research. We have a better understanding of the burden of childhood TB as well as a better idea of how to diagnose it. Our appreciation of pathophysiology is improved and with it investigators are beginning to consider pediatric TB as a heterogeneous...

The value of transcranial Doppler imaging in children with tuberculous meningitis

Purpose Transcranial Doppler imaging (TCDI) is potentially a valuable investigational tool in children with tuberculous meningitis (TBM), a condition often complicated by pathology relevant to Doppler imaging such as raised intracranial pressure (ICP) and cerebral vasculopathies. Methods Serial TCDI was performed on 20 TBM children with the aim of investigating cerebrovascular...

Pharmacokinetics and Safety of Moxifloxacin in Children With Multidrug-Resistant Tuberculosis

Background. Moxifloxacin is currently recommended at a dose of 7.5–10 mg/kg for children with multidrug-resistant (MDR) tuberculosis, but pharmacokinetic and long-term safety data of moxifloxacin in children with tuberculosis are lacking. An area under the curve (AUC) of 40–60 µg × h/mL following an oral moxifloxacin dose of 400 mg has been reported in adults. Methods. In a...

Executive Summary: Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

California, San Francisco; Jussi Saukkonen, MD, Boston University, Massachusetts; H. Simon Schaaf, MD, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa; Giovanni

Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy...

Preventive Therapy for Child Contacts of Multidrug-Resistant Tuberculosis: A Prospective Cohort Study

Background. Evidence is limited to guide the management of children exposed to multidrug-resistant (MDR) tuberculosis. We aimed to study the tolerability and toxicity of a standard preventive therapy regimen given to children exposed to infectious MDR tuberculosis, and explore risk factors for poor outcome. Methods. In this prospective cohort study in the Western Cape, South...

Culture-Confirmed Multidrug-Resistant Tuberculosis in Children: Clinical Features, Treatment, and Outcome

Background. Multidrug-resistant (MDR) tuberculosis in children is frequently associated with delayed diagnosis and treatment. There is limited evidence regarding the management and outcome of children with MDR-tuberculosis. Methods. All children <15 years of age with a diagnosis of culture-confirmed MDR-tuberculosis were included in this retrospective cohort study from 1 January...

Clinical presentation and outcome of Tuberculosis in Human Immunodeficiency Virus infected children on anti-retroviral therapy

Background The tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics are poorly controlled in sub-Saharan Africa, where highly active antiretroviral treatment (HAART) has become more freely available. Little is known about the clinical presentation and outcome of TB in HIV-infected children on HAART. Methods We performed a comprehensive file review of all children...

Isoniazid Plasma Concentrations in a Cohort of South African Children with Tuberculosis: Implications for International Pediatric Dosing Guidelines

Background. In most countries with a high burden of tuberculosis, children with tuberculosis are prescribed isoniazid at dosages of 4–6 mg/kg/day, as recommended by international authorities. Methods. We studied isoniazid concentrations in 56 hospitalized children (median age, 3.22 years; interquartile range [IQR], 1.58–5.38 years) who received isoniazid daily (median dosage, 5...

Culture-confirmed childhood tuberculosis in Cape Town, South Africa: a review of 596 cases

H Simon Schaaf Ben J Marais Andrew Whitelaw Anneke C Hesseling Brian Eley Gregory D Hussey Peter R Donald Background: The clinical, radiological and microbiological features of culture

A rapid method for detection of five known mutations associated with aminoglycoside-induced deafness

Background South Africa has one of the highest incidences of multidrug-resistant tuberculosis (MDR-TB) in the world. Concomitantly, aminoglycosides are commonly used in this country as a treatment against MDR-TB. To date, at least five mutations are known to confer susceptibility to aminoglycoside-induced hearing loss. The aim of the present study was to develop a rapid screening...

Multidrug Resistant Pulmonary Tuberculosis Treatment Regimens and Patient Outcomes: An Individual Patient Data Meta-analysis of 9,153 Patients

Vija Riekstina Jerome Robert Sarah Royce H. Simon Schaaf Kwonjune J. Seung Lena Shah Tae Sun Shim Sonya S. Shin Yuji Shiraishi Jose Sifuentes-Osornio Giovanni Sotgiu Matthew J. Strand Payam Tabarsi