Outcomes of Category II anti-tuberculosis treatment in Indian children

SETTING: The emerging threat of multidrug-resistant tuberculosis (MDR-TB) has cast doubt on the efficacy of Category II anti-tuberculosis treatment in retreatment cases. Data on outcomes of treatment with the Category II regimen in children are scarce. OBJECTIVE: To study outcomes of Category II anti-tuberculosis treatment in Indian children. DESIGN: Charts belonging to patients registered between 2004 and 2012 at the Paediatric Tuberculosis Clinic, All India Institute of Medical Sciences, New Delhi, India, were reviewed, and children receiving Category II anti-tuberculosis treatment were included in the study. Outcomes were recorded as treatment success and poor outcome, which included treatment failure and default. RESULTS: A total of 125 children (mean age 101.6 months, standard deviation 42.9; girls 58 [46.4%]) were initiated on Category II anti-tuberculosis treatment, mainly due to worsening clinical conditions (36.8%) and relapse (36%). Treatment success, treatment failure and default were recorded in respectively 80 (64%), 20 (16%) and 25 (20%) children. Children who were non-adherent to previous treatment tended to default from Category II treatment as well (11.8% in previous non-defaulters vs. 37.5% in previous defaulters, P = 0.004). CONCLUSION: Category II anti-tuberculosis treatment was effective in approximately 60% of children who had failed or defaulted from the previous regimen. All efforts should be made to isolate Mycobacterium tuberculosis and perform drug susceptibility testing to identify MDR-TB in children.