Clinical standards for drug-susceptible TB in children and adolescents
S S Chiang, Stephen M. Graham, H. Simon Schaaf, Ben J. Marais, Clemax Couto Sant’Anna, Sangeeta Sharma, Jeffrey R. Starke, Rina Triasih, Jay Achar, Farhana Amanullah, Lisa Armitage, Rafaela Baroni Aurílio, W Chris Buck, Rosella Centis, Chishala Chabala, Andrea T. Cruz, Anne‐Marie Demers, Karen Du Preez, Anthony Enimil, Jennifer Furin, Anthony J. Garcia‐Prats, N. E. Gonzalez, Graeme Hoddinott, Petros Isaakidis, Devan Jaganath, S. K. Kabra, Beate Kampmann, Alexander Kay, Ian Kitai, Elisa López‐Varela, Elizabeth Maleche‐Obimbo, Francesco Malaspina, Jürg Niederbacher Velásquez, James Nuttall, Jacquie Oliwa, Isadora Andrade, Carlos M. Pérez‐Vélez, Helena Rabie, James A. Seddon, Moorine Sekadde, Adong Shen, Alena Skrahina, Antoni Soriano‐Arandes, Andrew P. Steenhoff, Marc Tebruegge, Marco Tovar, Bazarragchaa Tsogt, Marieke M. van der Zalm, Henry Welch, Giovanni Battista Migliori
Abstract
BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents. METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document. RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent. CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB.