Dawn of a new era for treatment of Childhood TB

Dr Amitava Acharyya, CNS Correspondent, India
TB continues to be a major infectious disease among children.  Southeast Asia and Western Pacific regions are bearing more than 50% of the total childhood TB cases. India alone accounts for 27% of the global burden of paediatric TB. Nearly 5% of the new cases in India are reported among children. Early diagnosis and proper treatment plays a crucial role in not only improving cure rates but also in reducing the burden of drug sensitive as well as multi drug resistant TB (MDR-TB), the latter affecting 32,000 children globally.

The advancement in Childhood TB treatment was a major outcome of the 46th Union World Conference on Lung Health hosted by The International Union against Tuberculosis and Lung Disease (The Union) in Cape Town, South Africa from 3–6 December, 2015. It was there that the first announcement on availability of new palatable, flavoured and fixed dose combination (FDC) of paediatric TB drugs was made. Till now, no such child friendly anti TB drugs were available in the market.  Children had difficulty in eating the bitter pills meant for adults. Moreover the pills had to be broken/crushed to confirm to child specific dosage. Cases of children vomiting the medicines and/or refusing to gulp them down  have been quite common. Also, random breaking of the tablets often leads to inappropriate medicine doses, which could lead to development of MDR-TB due to dose inappropriateness.

Children are the future of society and the most beautiful gift of God. Yet more than 140,000 die every year from this curable disease. The clinical features are some short are different than adult tuberculosis patients. The common symptoms of TB in children are: unintended weight loss, poor physical growth, sweating at night, cough, swollen glands and chills. These symptoms are often mistaken to be those of other diseases, like pneumonia, LRTI, URTI etc. So, correct diagnosis often takes a long time to confirm the presence of TB.

Kashyap, the great Indian paediatrician has mentioned in Kashyap Samhita that medicines for children need to be palatable, sweet and attractive in order that children eat them for the entire course of treatment. This is all the more true for diseases like TB which needs at least 6 months of continuous treatment to get cured. This urgent need will now be met with the manufacture of the new dispersible anti TB tablets that are prepared in fixed dose combination comprising 3 commonly used TB drugs— rifampicin, isoniazid, and pyrazinamide—and are easy to administer.

Last but not the least—it is the right time to prioritize the control and care of childhood TB in National TB programmes and policy making around the world. The availability of the new child friendly formulations to treat drug sensitive TB will be a huge step forward to achieve the goal of ending TB by 2035.

Dr Amitava Acharyya, Citizen News Service - CNS
January 13, 2016

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