Updates have been made to the Sentinel Field Guide, which incorporate the most recent World Health Organization recommendations on the management of TB in children and adolescents. You can access the fifth edition of the Sentinel Field Guide here or on our Resources page.
Working with children/adolescents and their families as they undertake their DR-TB prevention and treatment journeys can be incredibly fulfilling. It also, however, requires a significant amount of patience and investment on the part of the counseling and health care teams. This guide from Medecins Sans Frontieres, Khayelitsha provides a “flexible approach” to counseling families affected by drug-resistant tuberculosis.
In 2018, a quality-assured, 125mg capsule of cycloserine became available to countries and programs treating children with rifampicin-resistant forms of tuberculosis. This capsule is an additional formulation to the standard adult capsule which is 250mg. Although not technically a “pediatric formulation”—since the capsule is not dispersible—the existence of this 125mg capsule should allow for more precise dosing and less drug wastage in young children, since the World Health Organization recommends a weight-based dose of 15-20mg/kg/day. For a number of reasons, however, there have been challenges with the availability of the 125mg cycloserine capsule, and countries may find they are either unable to obtain the smaller capsule or are unable to use the capsule in their countries. If the 125mg capsule is not available, it is recommended that the larger 250mg capsule be used. A practical approach to using the larger capsule is detailed in the attachment, along with more information on weight-based dosing for other TB drugs.
The Sentinel Project resource “Get the Facts about Drug-Resistant Tuberculosis: A Resource for Families” is now available on our site. It serves as a quick guide on DR-TB and how best to manage and treat it.
Get the Facts about Drug-Resistant Tuberculosis: A Resource for Families
There have been some important changes to the delamanid compassionate use protocol. Delamanid is available for compassionate use and can be obtained from the company at no charge on a patient-by-patient basis.
The company has made some changes to their access and eligibility criteria and these are summarized below. Perhaps most exciting is that the pediatric formulation of delamanid (a 25mg dispersible tablet) will also be available via compassionate use. This formulation is not yet on the market but is an important tool for younger children with RR-TB. We are thrilled the company has now made this formulation available for the children who need it.
Please find additional information below.
Delamanid Compassionate Use Patient Access Form
Updates to Delamanid Compassionate Use Protocol
Eligibility criteria
DLM treatment duration
Pediatric formulation
PV reporting timelines
The Paediatric Drug-Resistant TB Donation Initiative is led and funded by the Stop TB Partnership’s Global Drug Facility in partnership and with financial support from USAID.
Management of Multidrug-Resistant Tuberculosis in Children: A Field Guide / (Russian)
Standard Operating Procedures for Administration of Dispersible Formulations of Second-Line Drugs For Clinical/Nursing Personnel / (Russian) / (French)
Drug Sheets for Dispersible Formulations / (Russian) / (French)
DR-TB & Me: Caring for a child with drug resistant TB / (Russian)
Standard Operating Procedures for Storage and Administration of Dispersible Formulations of Second-Line Drugs for Pharmacy Personnel / (Russian) / (French)
Pediatric Formulations of Second-Line Drugs for the Treatment of Drug-Resistant Tuberculosis / (Russian)
Summary Points on Pediatric Formulations of Second-Line Drugs for Tuberculosis / (Russian)
In June 2018, the South African National Department of Health announced that bedaquiline will now be used to replace the injectable agent in routine treatment of rifampin-resistant and multidrug resistant tuberculosis (RR/MDR-TB) in patients over 12 years of age. We congratulate the leadership of the South African National TB program for taking this important step.
We note with some concern that children under the age of 12 years may be precluded from accessing the benefits of an all-oral RR/MDR-TB regimen. As such, we call for policies to support all-oral regimens for patients under 12 years of age in South Africa and globally. In partnership with the Desmond Tutu Tuberculosis Centre (DTTC) and Treatment Action Group (TAG), Sentinel Project has developed the following recommendations for injectable-free regimens for children under the age of 12 years.
Please download these recommendations here: Recommendations for Injectible-Free Regimens in Children with Rifampacin Resistant TB.
The Sentinel Project resource, “How to Care for People Exposed to Drug-Resistant Tuberculosis: A Practical Guide” is now available.
This Guide builds on World Health Organization (WHO) recommendations for the management of individuals who have been exposed to TB and DR-TB, but focuses more on the practical implementation of interventions that should take place in the post-exposure setting. While the WHO policies stress that investigating household contacts of TB patients must be done on an “urgent” basis for all contacts of a patient with DR-TB, there is limited information available on what these evaluations and interventions should include. Furthermore, many of the recommendations and tools that do exist only focus on medical issues, omitting other pressing psychosocial needs that must be routinely assessed as well. DR-TB affects not only individuals but their households as well. Even when only one person has become sick, the whole household requires some intervention to reduce discrimination, improve patient support, and avoid unnecessary morbidity and mortality. This Guide aims to provide a way of thinking about the challenges around those exposed to DR-TB. It also aims to provide guidance on DR-TB prevention and management strategies needed to address the enormous health threat presented by DR-TB, as well as the tools necessary to carry them out.
This Guide is available in English and Spanish.
For additional translations of the Field Guide, please send a note to Sentinel_Project@hms.harvard.edu.