Drug-resistant tuberculosis in children in Thailand

SETTING: Few data on drug-resistant (DR) tuberculosis (TB) in children are available in Thailand. OBJECTIVES: To evaluate the rate, clinical features and risk of DR-TB in children. DESIGN: Observational prospective study conducted in children diagnosed with TB at a tertiary care centre in Bangkok. RESULTS: Of 230 children diagnosed with TB, the median age was 6.5 years; 63% had identified adult source cases, and only 7% had received prior isoniazid treatment for latent tuberculous infection. Of the 195 (85%) specimens submitted, 57 (25%) were positive using culture or polymerase chain reaction. Of the 53 positive specimens available for drug susceptibility testing (DST), 18 (34%) had any resistance, 13 (24.5%) were monoresistant, 2 (3.8%) polyresistant and 3 (5.7%) were multidrug-resistant. In multivariate analysis, prior TB treatment (P < 0.001), presence of atelectasis (P = 0.039) or lobar consolidation (P = 0.012) on chest X-ray were associated with DR-TB. DR-TB required longer treatment but there were no differences in rate of cure, treatment completion or death. CONCLUSIONS: The high rate of DR-TB underscores the importance of routine DST. History of treatment and drug susceptibility in source cases was useful in guiding initial treatment in children.