Clinical Diagnosis of Drug Resistance/ Probable DR-TB in Children

The term probable Drug-resistant TB (DR-TB) would be applied to children where DR-TB is clinically suspected strongly but there is no bacteriologic confirmation and the decision regarding diagnosis and initiation of treatment is taken by the Nodal/ District DR-TB (N/DDR-TB) committee.

• It is most common in children and adults where their appropriate specimens fail to demonstrate M.tb and thus the resistance pattern cannot be determined (culture-negative TB) or access to the specimen is not easily possible (tuberculomas or abdominal tuberculosis, etc.)
• The consideration of initiation of the appropriate DR-TB regimen without bacteriological confirmation does not replace the need for a thorough and ongoing diagnostic evaluation, including consideration of non-TB causes, before initiation of DR-TB treatment.

Clinical Diagnosis of Drug-resistance/ Probable DR-TB in Children

• Children with a central nervous system disease and/or those with other life-threatening manifestations with risk factors for DR-TB may be treated as probable Multiple Drug-resistant TB (MDR-TB) even when their drug-susceptibility tests are awaited. 
• They should be initiated on treatment immediately, in consultation with the paediatrician in the NDR-TB committee, given the high risk of mortality. Further continuation of treatment can be decided based on their test results when available.
• DR-TB treatment is usually started in these patients based on their clinical and /or radiological deterioration (clinically diagnosed case of MDR-TB).
• All patients considered to have ‘probable’ MDR-TB should be presented to and discussed with the DR-TB committee followed by a decision to treat which ought to be made in consultation with the paediatrician.

Resources

• Guidelines for Programmatic Management of Drug-resistant TB in India, 2021.

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