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WHO Recommends Shorter Treatment for Non-Severe Pediatric TB

 

On March 21st, 2022, the World Health Organization (WHO) updated its guidelines on treatment of non-severe TB disease in children and adolescents. The new guidelines recommend a shorter duration of treatment and reduces the standard of care which is currently 6 months of therapy down to 4 months. These new recommendations were included in the WHO's "Management of tuberculosis in children and adolescents" guidelines that launched earlier this week. Alongside this shorter treatment recommendation came new recommendations that cover diagnostic approaches for TB, a new option for the treatment of TB meningitis, and the recommended use of bedaquiline and delamanid in young children with multidrug- and rifampicin-resistant TB. 

These new recommendations on a shorter treatment for children (3 months to under 10 years) and adolescents (10-16 years) with non-severe TB is a watershed moment. Reducing the treatment duration from 6 to 4 months in this group of individuals is expected to majorly impact health outcomes. Around the world, more than 1 million children become sick with Tuberculosis annually. The new guidelines are positioned to also reduce the cost of healtcare for these indivduals. 

These recommendations come after the publication of the SHINE clinical trial in the New England Journal of Medicine. The trial showed noninferiority of the 4 months treatment as compared to the standard 6 months. 

The objective of the new WHO guidelines is to "provide policy-makers and implementing partners with evidence-based recommendations on the entire cascade of care for children and adolescents...". The recommended treatment regimen consists of 2 months HRZ(E) and 2 months HR. Non-severe TB is defined as: "Peripheral lymph node TB; intrathoracic lymph node TB without airway obstruction; uncomplicated TB pleural effusion or paucibacillary, non-cavitary disease, confined to one lobe of the lungs, and without a miliary pattern."

WHO guidelines were last updated in 2014.

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