DRUG-RESISTANT TUBERCULOSIS AMONG URBAN THAI CHILDREN: A 10-YEAR REVIEW

Drug-resistant tuberculosis (DR-TB) has become an increasing public health concern. We conducted this retrospective chart review to determine the risk factors, susceptibility patterns, and clinical outcomes of children with DR-TB treated at the Queen Sirikit National Institute of Child Health, Bangkok, Thailand. Susceptibility results were available for 78 of the 91 patients (85.7%) with positive cultures for M. tuberculosis. Sensitivity of tuberculin skin testing for overall culture-confirmed tuberculosis with a cut-off point of 10 mm for human immunodeficiency virus (HIV)-uninfected cases was 76.9%. Using a 5-mm induration cut-off-point for tuberculin skin testing for HIV-infected cases, sensitivity was only 14.3%. Resistance to at least one anti-tubercular drug was found in 22 cases (28.2%), with streptomycin resistance being the most common (21.7%), followed by isoniazid (11.5%), rifampicin (5.1%), and ethambutol (5.1%). Multi-drug resistance (MDR) was observed in 3 cases (3.8%). A history of previous TB treatment and bone and joint involvement were associated with a significantly higher percentage of DR-TB: 18.2% vs 1.8% (p=0.0078) and 22.7 vs 1.8% (p=0.0018), respectively. Case fatality rates were 1.7% and 4.5% for drug-susceptible and DR-TB, respectively. Due to the high rate of resistance, streptomycin is not recommended as first time treatment of childhood tuberculosis in Thailand.