Changes of pediatric tuberculosis control and prevention strategies

doi:10.3969/j.issn.1000-6621.2018.02.003

Abstract

Abstract:

In response to the current situation of pediatric tuberculosis (TB), a series of guidelines and re-commendations have been published by World Health Organization (WHO) and Ministry of Health in various countries, which provide important guidance to regulate the diagnosis, treatment, prevention and management of pedia-tric TB. The management of children with TB is an important aspect of global TB control. The summary of pediatric TB teased from the publications of WHO since DOTS strategy proposed in 1991, including 4 guidelines, 10 recommendations, 2 statements, 2 handbooks, 2 roadmaps and 1 review, is useful to understand the changes in the prevention and control strategies for children with TB, promote the early diagnosis and treatment, solve current problems, and facilitate the popularization of the guidelines.

Key words: Child, Tuberculosis, Guidebooks, Diagnosis, Universal precautions, Therapeutic uses

Lin SUN,A-dong SHEN. Changes of pediatric tuberculosis control and prevention strategies[J]. Chinese Journal of Antituberculosis, 2018, 40(2): 128-134. doi: 10.3969/j.issn.1000-6621.2018.02.003

Figures/Tables 5

References 26

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年份	指南和建议
2006	《国家结核病规划关于儿童结核病处理指南》^[8]
2006	《乙胺丁醇的疗效与不良反应:儿童每日和间歇剂量的文献综述和建议》^[9]
2007	《儿童结核病研究议程》^[10]
2010	《儿童结核病的治疗(快速建议)》^[11]
2013	《儿童结核病防治路线图:争取实现“零死亡”》^[5]
2013	《Xpert MTB/RIF方法用于成人和儿童肺内和肺外结核病及利福平耐药的筛查》^[12]
2014	第2版《国家结核病规划关于儿童结核病处理指南》^[6]
2014	《儿童结核病培训手册》^[7]
2014	《Xpert MTB/RIF方法用于成人和儿童肺内和肺外结核病的诊断(更新版)》^[13]
2016	《德拉马尼在儿童和青少年(6~17岁)耐多药结核病治疗的应用指导》^[14]
2017	《使用适合儿童的复方抗结核药物制剂治疗儿童结核病的声明》^[15]

结核病类别	药物及治疗方案
HIV高流行、异烟肼高耐药率地区:疑似或确诊肺结核或淋巴结结核	2H-R-Z-E/4H-R
HIV低流行、异烟肼低耐药率地区:肺部病变广泛	2H-R-Z-E/4H-R
HIV低流行、异烟肼低耐药率地区:HIV阴性、疑似或确诊的肺结核或淋巴结结核	2H-R-Z/4H-R
疑似或确诊儿童结核性脑膜炎	2H-R-Z-E/10H-R
疑似或确诊儿童骨关节结核	2H-R-Z-E/10H-R

结核病类别	药物及治疗方案
HIV低发(HIV阴性儿童)和异烟肼低耐药地区
涂阴肺结核	2H-R-Z/4H-R
肺内淋巴结结核	2H-R-Z/4H-R
外周淋巴结结核	2H-R-Z/4H-R
广泛肺部病变	2H-R-Z-E/4H-R
涂阳肺结核	2H-R-Z-E/4H-R
重症肺外结核(除外结核性脑膜炎和骨关节结核)	2H-R-Z-E/4H-R
HIV高发和(或)异烟肼高耐药地区
涂阳肺结核	2H-R-Z-E/4H-R
涂阴肺结核伴或不伴广泛实质病变	2H-R-Z-E/4H-R
除结核性脑膜炎和骨关节结核外的各类型肺外结核	2H-R-Z-E/4H-R
各个地区
结核性脑膜炎和骨关节结核	2H-R-Z-E/10H-R

药物分组药物名称	儿童日剂量(mg/kg)	儿童日最大剂量(mg)^a
第一组:一线口服药物^b
乙胺丁醇	15	-
吡嗪酰胺	-	-
第二组:注射类药物^c
氨基糖苷类
阿米卡星	15~22.5	1000
卡那霉素	15~30	1000
多肽类
卷曲霉素	15~30	1000
第三组:氟喹诺酮类
氧氟沙星	15~20	800,2次/d
左氧氟沙星	7.5~10	750
莫西沙星	7.5~10	400
第四组:二线口服药物^d
乙硫异烟胺或丙硫异烟胺	15~20	1000,2次/d
环丝氨酸或特立齐酮	10~20	1000,1次/d或2次/d
对氨基水杨酸^e	150	12000,2次/d或3次/d

药物分组	药物名称	注意事项
A组	左氧氟沙星	A组按优先选用原则从高到低排列
	莫西沙星
	加替沙星
B组	阿米卡星	当前3种药物无法使用时可选用链霉素替代,仅链霉素耐药不能定义为
	卷曲霉素	广泛耐药结核病
	卡那霉素
	(链霉素)
C组	乙硫异烟胺或丙硫异烟胺	C组按优先选用原则从高到低排列
	环丝氨酸或特立齐酮
	利奈唑胺
	氯法齐明
D组
D1	吡嗪酰胺
	乙胺丁醇
	高剂量异烟肼
D2	贝达喹啉	贝达喹啉或德拉马尼可加到长疗程方案中用于替代或加强其他二线药物
	德拉马尼
D3	对氨基水杨酸	碳青霉烯类和克拉维酸共同使用,在此配方中克拉维酸只和阿莫西林联
	亚胺培南或西司他丁	用;氨硫脲在使用前,需要检测患者的HIV结果且确保为阴性
	美罗培南
	阿莫西林-克拉维酸
	(氨硫脲)