Management of childhood and adolescent latent tuberculous infection (LTBI) in Germany, Austria and Switzerland
Open Access
- 10 May 2021
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 16 (5), e0250387
- https://doi.org/10.1371/journal.pone.0250387
Abstract
Majority of active tuberculosis (TB) cases in children in low-incidence countries are due to rapid progression of infection (latent TB infection (LTBI)) to disease. We aimed to assess common practice for managing paediatric LTBI in Austria, Germany and Switzerland prior to the publication of the first joint national guideline for paediatric TB in 2017. Online-based survey amongst pediatricians, practitioners and staff working in the public health sector between July and November 2017. Data analysis was conducted using IBM SPSS. A total of 191 individuals participated in the survey with 173 questionnaires included for final analysis. Twelve percent of respondents were from Austria, 60% from Germany and 28% from Switzerland. Proportion of children with LTBI and migrant background was estimated by the respondents to be >50% by 58%. Tuberculin skin test (TST) and interferon-γ-release-assay (IGRA), particularly Quantiferon-gold-test, were reported to be used in 86% and 88%, respectively. In children > 5 years with a positive TST or IGRA a chest x-ray was commonly reported to be performed (28%). Fifty-three percent reported to take a different diagnostic approach in children ≤ 5 years, mainly combining TST, IGRA and chest x-ray for initial testing (31%). Sixty-eight percent reported to prescribe isoniazid-monotherapy: for 9 (62%), or 6 months (6%), 31% reported to prescribe combination therapy of isoniazid and rifampicin. Dosing of isoniazid and rifampicin below current recommendations was reported by up to 22% of respondents. Blood-sampling before/during LTBI treatment was reported in >90% of respondents, performing a chest-X-ray at the end of treatment by 51%. This survey showed reported heterogeneity in the management of paediatric LTBI. Thus, regular and easily accessible educational activities and national up-to-date guidelines are key to ensure awareness and quality of care for children and adolescents with LTBI in low-incidence countries.Funding Information
- Ludwig Maximilian University Munich, Germany
This publication has 37 references indexed in Scilit:
- Preventive Therapy for Child Contacts of Multidrug-Resistant Tuberculosis: A Prospective Cohort StudyClinical Infectious Diseases, 2013
- Management of children exposed to multidrug-resistant Mycobacterium tuberculosisThe Lancet Infectious Diseases, 2012
- Three Months of Rifapentine and Isoniazid for Latent Tuberculosis InfectionThe New England Journal of Medicine, 2011
- Pharmacokinetics of Isoniazid, Rifampin, and Pyrazinamide in Children Younger than Two Years of Age with Tuberculosis: Evidence for Implementation of Revised World Health Organization RecommendationsAntimicrobial Agents and Chemotherapy, 2011
- Antituberculosis Drug-Induced Hepatotoxicity in ChildrenPediatric Reports, 2011
- Isoniazid pharmacokinetic studies of the 1960s: considering a higher isoniazid dose in childhood tuberculosisScandinavian Journal of Infectious Diseases, 2010
- The Likelihood of an Indeterminate Test Result from a Whole-Blood Interferon-γ Release Assay for the Diagnosis of Mycobacterium tuberculosis Infection in Children Correlates With Age and Immune StatusThe Pediatric Infectious Disease Journal, 2009
- The Effectiveness of a 9-Month Regimen of Isoniazid Alone versus 3- and 4-Month Regimens of Isoniazid plus Rifampin for Treatment of Latent Tuberculosis Infection in Children: Results of an 11-Year Randomized StudyClinical Infectious Diseases, 2007
- Empfehlungen für die Umgebungsuntersuchungen bei TuberkuloseDas Gesundheitswesen, 2007
- Short-Course Therapy with Rifampin plus Isoniazid, Compared with Standard Therapy with Isoniazid, for Latent Tuberculosis Infection: A Meta-analysisClinical Infectious Diseases, 2005