Failure of chemoprophylaxis with standard antituberculosis agents in child contacts of multidrug-resistant tuberculosis cases

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dc.contributor.authorSneag D.B.
dc.contributor.authorSchaaf H.S.
dc.contributor.authorCotton M.F.
dc.contributor.authorZar H.J.
dc.date.accessioned2011-05-15T16:00:06Z
dc.date.available2011-05-15T16:00:06Z
dc.date.issued2007
dc.description.abstractBACKGROUND: There is little published information on optimal chemoprophylaxis for children with multidrug-resistant tuberculosis (MDR-TB) contacts. Current guidelines of World Health Organization suggest that isoniazid (INH), the standard first-line chemoprophylaxis, be used for those exposed to MDR-TB. METHODS: This is a retrospective review of medical records of 5 children residing in the Western Cape Province, South Africa, who developed MDR-TB while receiving conventional chemoprophylaxis with either INH or a combination of INH, rifampin, and pyrazinamide. RESULTS: Adult MDR-TB source cases were identified for all children and resistance patterns of patient and source case isolates matched in all cases. The median age of the patients was 0.4 years. One patient participated in a trial of INH chemoprophylaxis for HIV-infected children. Four HIV-uninfected infants presented with TB-related symptoms several months after being given chemoprophylaxis because of a known source case. Stigmata of TB were cough >3 weeks in 4, weight loss or a history of failing to thrive in 3, fever in 2 infants, and reported night sweats in 1. Chest radiographs at diagnosis revealed lymphadenopathy, lobar opacification, and airway narrowing. All patients were treated for varying time periods at a TB referral institution in the Western Cape. CONCLUSIONS: Standard, first-line anti-TB agents were inadequate to prevent MDR-TB in children exposed to MDR-TB contacts. Second-line chemoprophylaxis, reflecting the susceptibility profile of the source case's isolate, with at least 2 drugs with activity against the drug-resistant isolate for 6-12 months should be considered. © 2007 Lippincott Williams & Wilkins, Inc.
dc.description.versionArticle
dc.identifier.citationPediatric Infectious Disease Journal
dc.identifier.citation26
dc.identifier.citation12
dc.identifier.issn8913668
dc.identifier.other10.1097/INF.0b013e31814523e4
dc.identifier.urihttp://hdl.handle.net/10019.1/11530
dc.subjectisoniazid
dc.subjectpyrazinamide
dc.subjectrifampicin
dc.subjectadolescent
dc.subjectarticle
dc.subjectchemoprophylaxis
dc.subjectchild
dc.subjectclinical article
dc.subjectclinical trial
dc.subjectcoughing
dc.subjectdrug activity
dc.subjectdrug sensitivity
dc.subjectfemale
dc.subjecthuman
dc.subjectHuman immunodeficiency virus infected patient
dc.subjectHuman immunodeficiency virus infection
dc.subjectinfant
dc.subjectlymphadenopathy
dc.subjectmale
dc.subjectmedical record review
dc.subjectmultidrug resistance
dc.subjectnight sweat
dc.subjectpriority journal
dc.subjectthorax radiography
dc.subjecttuberculosis
dc.subjectweight reduction
dc.subjectAdolescent
dc.subjectAntibiotic Prophylaxis
dc.subjectAntitubercular Agents
dc.subjectContact Tracing
dc.subjectFemale
dc.subjectHumans
dc.subjectInfant
dc.subjectIsoniazid
dc.subjectMale
dc.subjectMycobacterium tuberculosis
dc.subjectPyrazinamide
dc.subjectRifampin
dc.subjectTreatment Failure
dc.subjectTuberculosis, Multidrug-Resistant
dc.titleFailure of chemoprophylaxis with standard antituberculosis agents in child contacts of multidrug-resistant tuberculosis cases
dc.typeArticle
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