Clinical standards for drug-susceptible TB in children and adolescents.
Chiang SS., Graham SM., Schaaf HS., Marais BJ., Sant'Anna CC., Sharma S., Starke JR., Triasih R., Achar J., Amanullah F., Armitage LY., Aurilio RB., Buck WC., Centis R., Chabala C., Cruz AT., Demers A-M., du Preez K., Enimil A., Furin J., Garcia-Prats AJ., Gonzalez NE., Hoddinott G., Isaakidis P., Jaganath D., Kabra SK., Kampmann B., Kay A., Kitai I., Lopez-Varela E., Maleche-Obimbo E., Malaspina FM., Velásquez JN., Nuttall JJC., Oliwa JN., Andrade IO., Perez-Velez CM., Rabie H., Seddon JA., Sekadde MP., Shen A., Skrahina A., Soriano-Arandes A., Steenhoff AP., Tebruegge M., Tovar MA., Tsogt B., van der Zalm MM., Welch H., Migliori GB.
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.