Treatment of Pulmonary MDR/RR-TB in Children Under 14 or During Pregnancy and Breastfeeding
This protocol addresses pulmonary multidrug- or rifampicin-resistant TB (MDR/RR-TB), with or without fluoroquinolone resistance, in patients who are either younger than 14 years or pregnant or breastfeeding — populations for whom the standard first-line MDR-TB regimen may not be an option.
Clinical Scenario
Age < 14 years
Pregnancy
Breastfeeding
Pulmonary MDR/RR-TB with or without fluoroquinolone resistance, in patients unable to receive the currently recommended 6-month BPaLM regimen — for example, due to restricted access to pretomanid, age below 14 years, or pregnancy and breastfeeding.
Treatment Approach
A structured 6-month combination regimen is recommended, built around bedaquiline and delamanid. Regimen composition is guided by confirmed fluoroquinolone susceptibility or resistance results, with one agent added or removed accordingly.
Full regimen composition, drug selection rules, weight-based adjustments for children, and complete administration details are in the structured protocol.
Treatment Goals
Sputum culture conversion and clinical and radiological response by month 4; negative cultures at months 5 and 6.
References
- WHO suggests the use of a 6-month treatment regimen composed of bedaquiline, delamanid, linezolid (600 mg), levofloxacin, and clofazimine (BDLLfxC) in MDR/RR-TB patients with or without fluoroquinolone resistance.
- This short regimen is particularly appropriate for people who are unable to benefit from the currently recommended 6-month BPaLM regimen owing, for example, to restricted access to pretomanid, being aged younger than 14 years, or being pregnant or breastfeeding.
- These regimen variations should be given for a total of at least 24 weeks (i.e. 6 months).
- In cases of quinolone susceptibility, clofazimine should be dropped and the regimen started or continued as bedaquiline, delamanid, linezolid and levofloxacin (BDLLfx). In cases of resistance to fluoroquinolones, levofloxacin should be dropped and the regimen started or continued as bedaquiline, delamanid, linezolid and clofazimine (BDLC).
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