Rifampicin-Resistant (RR), Pre-XDR and XDR Tuberculosis, in Children

General Measures

Referral

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A15.0-3/A15.7-8/A16.0-2/A16.7-8 + (U50.00-01+U50.20-21) + (B20.0)

Never treat for drug resistant TB without laboratory confirmation, either by molecular or phenotypic (culture and sensitivity) results.  All cases should be discussed with a designated specialist drug resistant TB centre.

GENERAL MEASURES

Suspect drug-resistant TB when any of the features listed below is present:

• A known source case (or contact) with drug resistant TB or high-risk source case, e.g. on TB therapy who was recently released from prison
• A patient with confirmed treatment adherence that remains smear positive after 2 months of 1st line TB treatment
• Any severely ill child with TB who failed to improve, or got worse on TB treatment
• Patients who defaulted TB treatment (> 2 months)
• History of treatment interruption (< 1 month) or relapse at some point during their TB therapy
• With recurrent TB disease after completion of TB treatment (re-treatment case)

Management of drug resistant TB should be conducted in dedicated drug resistant TB clinics and hospitals with appropriate infection control measures. Initiate treatment in consultation with a designated expert. An uninterrupted medicine supply, direct supervision with proper education and counselling is necessary.

REFERRAL

All children with suspected drug resistant TB to a medical officer at primary care level for initiation of therapy.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-4-Version 1.0_16 September 2024

Chapter 17: Respiratory Conditions_17.4 Pulmonary Tuberculosis (TB)_17.4.4 Drug-Resistant Tuberculosis (MDR TB)_17.4.4.3 Rifampicin-Resistant (RR), Pre-XDR and XDR Tuberculosis, in Children