New Hope for Kids Fighting Superbugs: Delamanid & Bedaquiline
"A review reveals the potential of delamanid and bedaquiline in treating drug-resistant tuberculosis in children, offering a beacon of hope in the fight against these challenging infections."
Tuberculosis (TB), especially in its drug-resistant forms, remains a major global health challenge, affecting millions, including children. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) require lengthy, expensive treatments with often suboptimal outcomes due to side effects and treatment failures.
The World Health Organization (WHO) has updated its guidelines for designing MDR-TB treatment regimens, incorporating new drugs like delamanid and bedaquiline. These drugs are typically reserved for adults under strict monitoring, but recent data has led to the recommendation of delamanid for children over 6 years old.
A systematic review was conducted to evaluate the efficacy, safety, and tolerability of delamanid and bedaquiline in children with confirmed MDR/XDR-TB, providing crucial insights for clinicians and families facing these difficult diagnoses.
Complex Regimens and Side Effects
Treatment for drug-resistant tuberculosis uses medicines different from those used for latent TB infection or drug-susceptible active TB, and these medicines can cause different side effects. WHO guidance addresses regimen design for isoniazid-resistant, rifampicin-resistant, multidrug-resistant, and extensively drug-resistant TB, as well as Mycobacterium bovis disease. WHO's latest recommendations include two six-month, all-oral regimens for people with MDR/RR-TB, while the Nix-TB study reported a 90% treatment success rate for an alternative six-month bedaquiline, pretomanid, and linezolid regimen for XDR or MDR-TB.
Delamanid and Bedaquiline: Promising Options for Children with Drug-Resistant TB?
The study focused on finding scientific evidence regarding the use of delamanid or bedaquiline in children with MDR/XDR-TB. Researchers searched databases like PubMed and Embase for relevant articles published in English up to December 31, 2016.
- Limited Evidence: The review found very few studies specifically addressing the use of delamanid and bedaquiline in children with drug-resistant TB.
- Delamanid Shows Promise: The available studies, though limited, suggest that delamanid may be a valuable option for children with MDR/XDR-TB, particularly when other treatment options have been exhausted.
- Bedaquiline Data Lacking: Unfortunately, no studies were found that specifically investigated the use of bedaquiline in children.
A Growing Research Effort
Research on drug-resistant tuberculosis includes international collaboration and basic research involving leading institutions in Mexico, Argentina, and Colombia, often funded by international partners. The Harvard University Partners in Health initiative and the Maugeri Scientific Institute were among the top 10 most active institutions worldwide by published MDR-TB articles in the cited study. Recent reviews continue to describe TB as a major global health problem and emphasize the need for new therapeutic options because treatment success rates for drug-resistant TB remain low.
Limited Pediatric Evidence
Evidence for using delamanid and bedaquiline in children with multidrug-resistant or extensively drug-resistant tuberculosis remains limited. A systematic review reported that, although its methodology was rigorous, its findings were constrained by the paucity of available studies on new anti-TB drugs in children. This limitation means that promising treatment options cannot be supported by the same depth of pediatric evidence as more established approaches.
The Future of Treating Drug-Resistant TB in Children
The review underscores the urgent need for more research on the use of new anti-TB drugs in children. While delamanid shows promise, the lack of data on bedaquiline highlights a significant gap in our knowledge.
Preventing an Untreatable Future
The CDC warns that unchecked drug-resistant TB could continue spreading and become more resistant to treatment, potentially creating a future in which TB is no longer curable and TB-related deaths substantially increase. The Lancet identifies several priorities for controlling drug-resistant TB: improving current regimens, finding alternatives with lower toxicity, personalizing treatment, expanding comprehensive TB care services, and ensuring access to rapid drug-susceptibility testing. Together, these priorities point toward treatments that are not only more effective, but also safer, more tailored, and easier to deliver.
A Global Treatment Challenge
Drug-resistant TB remains a major global health challenge because current approaches have limitations in diagnosis and treatment. Reviews describe MDR and XDR tuberculosis as especially difficult to treat, with antibiotic abuse and long treatment protocols contributing to increasing resistance to commonly prescribed drugs. Other documented challenges include prolonged treatment, severe side effects, limited efficacy of existing therapies, and a substantial gap between people who need second-line therapy and those who receive it.
Ongoing clinical trials are crucial to gathering the evidence needed to develop safe and effective treatment guidelines for children with MDR/XDR-TB. These trials will help determine optimal dosages, identify potential side effects, and assess long-term outcomes.
For families and healthcare providers, staying informed about the latest research and treatment options is essential. Consulting with TB specialists and participating in clinical trials can provide access to cutting-edge therapies and contribute to advancing our understanding of these challenging infections.