# Burden and Patterns of Multidrug-Resistant Tuberculosis in Pediatric and Adolescent Patients at a Tertiary Care Hospital in Pakistan

## TL;DR

This study examines the prevalence and resistance patterns of multidrug-resistant tuberculosis in children and adolescents in Pakistan, highlighting the need for better diagnostics and treatment.

## Contribution

The study provides new insights into MDR-TB resistance patterns and demographic factors in pediatric populations in a developing country setting.

## Key findings

- 15.9% of pediatric and adolescent patients had MDR-TB, with resistance to isoniazid, rifampicin, and pyrazinamide.
- Tuberculous meningitis and malnutrition were highly prevalent among the studied patients.
- Most cases originated from Punjab, indicating regional concentration of the disease burden.

## Abstract

Background

Multidrug-resistant tuberculosis (MDR-TB) presents a significant global health challenge, particularly in developing countries. This study focuses on the burden and pattern of pediatric and adolescent MDR-TB in a tertiary care hospital setting.

Aims/objectives

The main objective is to evaluate MDR-TB’s prevalence and resistance patterns among pediatric and adolescent patients, highlighting critical demographic factors and resistance trends.

Materials and methods

The study utilized a prospective analytical design in two tertiary care facilities, focusing on children aged four months to 18 years diagnosed with extra-pulmonary tuberculosis. Data on demographic profiles, clinical outcomes, and drug resistance patterns were collected and analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 27.0, Armonk, NY).

Results

Out of 99 enrolled participants, 63 (63.64%) met the inclusion criteria. The mean age was 70.22±48.90 months. A significant proportion, 60 (95.2%) of the cases, originated from Punjab. Notably, 10 (15.9%) of the cultures demonstrated MDR, with specific resistance observed to isoniazid (INH) in 10 (15.9%) cases, rifampicin (RIF) in 11 (17.5%) cases, and pyrazinamide (PZA) in seven (11.1%) cases. The study also recorded a high prevalence of tuberculous meningitis, affecting 52 (82.5%) participants, and malnutrition, affecting 49 (77.8%).

Conclusions

MDR-TB in 10 (15.9%) of the study children and adolescents presenting in Pakistan’s specialized health centres is a notable burden. This points to a need for better diagnostic methods and treatment plans for pediatric patients. Implementing advanced diagnostics and personalized therapies is crucial for managing MDR-TB in susceptible demographics. Our findings emphasize the importance of updating treatment protocols to tackle the impacts of MDR-TB and its evolving resistance.