Nature Medicine | Spoonful of Medicine

Childhood tuberculosis treatment remains imprecise science

By Julie Manoharan

fighttuberculosis.jpgLast year, the World Health Organization released updated procedures on how best to tackle the global scourge of tuberculosis. The fourth edition of the “Treatment of tuberculosis: Guidelines” recommended, among other changes, increasing the dosage of tuberculosis medication required to treat children. But, in a sense, the new guidance provided a destination without a map: it failed to address the larger problem of how to improve the accuracy of pediatric dosing.

In recent months, researchers have pointed to a host of problems plaguing the diagnosis and treatment of tuberculosis in children, especially those younger than age 5. For example, at a June workshop held by a taskforce of the US Centers for Disease Control and Prevention, Steve Graham of the Royal Children’s Hospital in Melbourne, Australia called for new and better means of pediatric tuberculosis diagnosis, which can be complicated by concurrent ailments such as malnourishment, HIV infection and pneumonia. And, in September, scientists noted that a negative result from the new interferon-gamma release assays cannot definitively rule out tuberculosis in children (Pediatr. Infect. Dis. J. 30, 817–818, 2011). Also in September, another group urged that animal models for tuberculosis “must be designed and utilized in a manner that is also pertinent to the pediatric population” by addressing age-related variance in drug metabolism (Pharmacol Res. 64, 176–179, 2011).

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Image: 1930s US poster via Wikimedia Commons

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