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1. Recommendations Concerning the First-Line Treatment of Children with Tuberculosis

Author

Principi, Nicola, Galli, Luisa, Lancella, Laura, Tadolini, Marina, Migliori, Giovanni Battista, Villani, Alberto, Esposito, Susanna, Bosis, Samantha, Tagliabue, Claudia, Senatore, Laura, Ascolese, Beatrice, Cursi, Laura, Grandin, Annalisa, Marabotto, Caterina, de Martino, Maurizio, Chiappini, Elena, Montagnani, Carlotta, Ciofi, Daniele, Festini, Filippo, Anziati, Martina, Becciani, Sabrina, Remaschi, Giulia, Sollai, Sara, Tersigni, Chiara, Venturini, Elisabetta, Guarino, Alfredo, Vecchio, Andrea Lo, Scotto, Riccardo, Bernardi, Filippo, Bertazzoni, Elisa, Blasi, Francesco, Assante, Luca, Castagnola, Elio, Losurdo, Giuseppe, Codecasa, Luigi, Di Mauro, Giuseppe, Faccini, Marino, Gabiano, Clara, Garazzino, Silvia, Le Serre, Daniele, Raffaldi, Irene, Marseglia, Gianluigi, Mascolo, Amelia, Di Comite, Amelia, Stronati, Mauro, D'Ambrosio, Lia, Centis, Rosella, Cirillo, Daniela, Tortoli, Enrico, Pasinato, Angela, Russo, Cristina, Scaglione, Franco, Scala, Elisabetta, Tomà, Paolo, Bocchino, Marialuisa, Matteelli, Alberto, Scaglione, Francesco, LO VECCHIO, ANDREA, BOCCHINO, MARIALUISA, Principi, Nicola, Galli, Luisa, Lancella, Laura, Tadolini, Marina, Migliori, Giovanni Battista, Villani, Alberto, Esposito, Susanna, Bosis, Samantha, Tagliabue, Claudia, Senatore, Laura, Ascolese, Beatrice, Cursi, Laura, Grandin, Annalisa, Marabotto, Caterina, de Martino, Maurizio, Chiappini, Elena, Montagnani, Carlotta, Ciofi, Daniele, Festini, Filippo, Anziati, Martina, Becciani, Sabrina, Remaschi, Giulia, Sollai, Sara, Tersigni, Chiara, Venturini, Elisabetta, Guarino, Alfredo, Vecchio, Andrea Lo, Scotto, Riccardo, Bernardi, Filippo, Bertazzoni, Elisa, Blasi, Francesco, Bocchino, Marialuisa, Assante, Luca, Castagnola, Elio, Losurdo, Giuseppe, Codecasa, Luigi, Di Mauro, Giuseppe, Faccini, Marino, Gabiano, Clara, Garazzino, Silvia, Le Serre, Daniele, Raffaldi, Irene, Marseglia, Gianluigi, Mascolo, Amelia, Di Comite, Amelia, Stronati, Mauro, D'Ambrosio, Lia, Centis, Rosella, Cirillo, Daniela, Tortoli, Enrico, Pasinato, Angela, Russo, Cristina, Scaglione, Franco, Scala, Elisabetta, Tomà, Paolo, Matteelli, Alberto, Scaglione, Francesco, LO VECCHIO, Andrea, For the Italian Pediatric TB Study Group, Null, and DI COMITE, Amelia

Subjects
0301 basic medicine, Pediatrics, medicine.medical_specialty, Tuberculosis, Tuberculosi, 030106 microbiology, Drug Resistance, Breastfeeding, Antitubercular Agents, Child, Drug Resistance, Microbial, Humans, Isoniazid, Medication Adherence, Tuberculosis, Pulmonary, Tuberculous meningitis, 03 medical and health sciences, Antitubercular Agent, Microbial, 0302 clinical medicine, Pharmacotherapy, 030225 pediatrics, medicine, Pharmacology (medical), Adverse effect, Ethambutol, Perinatology and Child Health, business.industry, Tuberculous pericarditis, Pulmonary, Pyrazinamide, medicine.disease, Settore MED/38, Surgery, Pediatrics, Perinatology and Child Health, business, medicine.drug, Human
Abstract

This document describes the recommendations of a group of scientific societies concerning the first-line therapeutic approach to paediatric tuberculosis (TB). The treatment of pulmonary TB should be based on the existence of parenchymal involvement and the risk of antibiotic resistance. The treatment of extra-pulmonary TB is based on the regimens used for severe pulmonary TB. The administration of corticosteroids is recommended only in cases of miliary TB, tuberculous meningitis and tuberculous pericarditis. Vitamin B6 may be indicated in the case of isoniazid-treated TB in breastfeeding infants, severely malnourished subjects, or patients with other diseases at high risk of vitamin deficiency. Once having started treatment, children with TB should be carefully followed up in order to evaluate compliance, the response to treatment, the need for treatment changes, and the presence of drug-related adverse events. Primary care paediatricians can support reference centres in providing family healthcare education and encouraging treatment compliance.

Published
2016

2. How to manage children who have come into contact with patients affected by tuberculosis

Author

Lancella, Laura, Vecchio, Andrea Lo, Chiappini, Elena, Tadolini, Marina, Cirillo, Daniela, Tortoli, Enrico, de Martino, Maurizio, Guarino, Alfredo, Principi, Nicola, Villani, Alberto, Esposito, Susanna, Galli, Luisa, Cursi, Laura, Grandin, Annalisa, Marabotto, Caterina, Scotto, Riccardo, Montagnani, Carlotta, Ciofi, Daniele, Festini, Filippo, Anziati, Martina, Becciani, Sabrina, Remaschi, Giulia, Sollai, Sara, Tersigni, Chiara, Venturini, Elisabetta, Russo, Cristina, Bosis, Samantha, Tagliabue, Claudia, Senatore, Laura, Ascolese, Beatrice, Bernardi, Filippo, Bertazzoni, Elisa, Blasi, Francesco, BOCCHINO, MARIALUISA, Assante, Luca, Castagnola, Elio, Losurdo, Giuseppe, Codecasa, Luigi, Di Mauro, Giuseppe, Faccini, Marino, Gabiano, Clara, Garazzino, Silvia, Le Serre, Daniele, Raffaldi, Irene, Marseglia, Gianluigi, Mascolo, Amelia, Di Comite, Amelia, Stronati, Mauro, Matteelli, Alberto, Migliori, Giovanni Battista, Centis, Rossella, D'Ambrosio, Lia, Pasinato, Angela, Scaglione, Franco, Scala, Elisabetta, Tomà, Paolo, Lancella, Laura, Vecchio, Andrea Lo, Chiappini, Elena, Tadolini, Marina, Cirillo, Daniela, Tortoli, Enrico, de Martino, Maurizio, Guarino, Alfredo, Principi, Nicola, Villani, Alberto, Esposito, Susanna, Galli, Luisa, Cursi, Laura, Grandin, Annalisa, Marabotto, Caterina, Scotto, Riccardo, Montagnani, Carlotta, Ciofi, Daniele, Festini, Filippo, Anziati, Martina, Becciani, Sabrina, Remaschi, Giulia, Sollai, Sara, Tersigni, Chiara, Venturini, Elisabetta, Russo, Cristina, Bosis, Samantha, Tagliabue, Claudia, Senatore, Laura, Ascolese, Beatrice, Bernardi, Filippo, Bertazzoni, Elisa, Blasi, Francesco, Bocchino, Marialuisa, Assante, Luca, Castagnola, Elio, Losurdo, Giuseppe, Codecasa, Luigi, Di Mauro, Giuseppe, Faccini, Marino, Gabiano, Clara, Garazzino, Silvia, Le Serre, Daniele, Raffaldi, Irene, Marseglia, Gianluigi, Mascolo, Amelia, Di Comite, Amelia, Stronati, Mauro, Matteelli, Alberto, Migliori, Giovanni Battista, Centis, Rossella, D'Ambrosio, Lia, Pasinato, Angela, Scaglione, Franco, Scala, Elisabetta, and Tomà, Paolo

Subjects
Pulmonary and Respiratory Medicine, Microbiology (medical), Pediatrics, medicine.medical_specialty, Tuberculosis, Contacts, Tuberculosi, IGRA, LTBI, Multidrug-resistant tuberculosis, Mycobacterium tuberculosis, Disease, Mycobacterium tuberculosi, Article, lcsh:Infectious and parasitic diseases, Molecular typing, Contact, Medicine, lcsh:RC109-216, Index case, lcsh:RC705-779, Immune status, biology, business.industry, Transmission (medicine), lcsh:Diseases of the respiratory system, biology.organism_classification, medicine.disease, Multidrug-resistant tuberculosi, Infectious Diseases, Chemoprophylaxis, Immunology, business
Abstract

Childhood tuberculosis (TB) indicates a recent infection, particularly in children aged

Published
2015

3. Recommendations for treating children with drug-resistant tuberculosis

Author

Galli L., Lancella L., Garazzino S., Tadolini M., Matteelli A., Migliori G. B., Principi N., Villani A., Esposito S. Italian Pediatric TB Study Group: Samantha Bosis, Claudia Tagliabue, Laura Senatore, Beatrice Ascolese, Laura Cursi, Annalisa Grandin, Caterina Marabotto, Maurizio de Martino, Elena Chiappini, Carlotta Montagnani, Daniele Ciofi, Filippo Festini, Martina Anziati, Sabrina Becciani, Giulia Remaschi, Sara Sollai, Chiara Tersigni, Elisabetta Venturini, Alfredo Guarino, Andrea Lo Vecchio, Riccardo Scotto, Fi lippo Bernardi, Elisa Bertazzoni, Francesco Blasi, Marialuisa Bocchino, Luca Assante, Elio Castagnola, Giuseppe Losurdo, Giannina Gaslini, Luigi Codec, Giuseppe Di Mauro, Marino Faccini, Clara Gabiano, Daniele Le Serre, Irene Raffaldi, Regina Margherita, Gianluigi Marseglia, Amelia Mascolo, Mauro Stronati, Rosella Centis, Lia D'Ambrosio, Angela Pasinato, Cristina Russo, Franco Scaglione, Elisabetta Scala, Paolo Tomà, Susanna Esposito, Luisa Galli, Laura Lancella, Nicola Principi, Samantha Bosis, Silvi a Garazzino, Alberto Villani, Filippo Bernardi, Luigi Codecasa, Alberto Matteelli, Enrico Tortoli, Francesco Scaglione, Daniela Cirillo, Giovanni Battista Migliori, Marina Tadolini, L., Galli, L., Lancella, S., Garazzino, M., Tadolini, A., Matteelli, G. B., Migliori, N., Principi, A., Villani, Italian Pediatric TB Study Group: Samantha Bosis, Esposito S., Tagliabue, Claudia, Senatore, Laura, Ascolese, Beatrice, Cursi, Laura, Grandin, Annalisa, Marabotto, Caterina, de Martino, Maurizio, Chiappini, Elena, Montagnani, Carlotta, Ciofi, Daniele, Festini, Filippo, Anziati, Martina, Becciani, Sabrina, Remaschi, Giulia, Sollai, Sara, Tersigni, Chiara, Venturini, Elisabetta, Guarino, Alfredo, LO VECCHIO, Andrea, Scotto, Riccardo, lippo Bernardi, Fi, Bertazzoni, Elisa, Blasi, Francesco, Bocchino, Marialuisa, Assante, LUCA ROSARIO, Castagnola, Elio, Losurdo, Giuseppe, Gaslini, Giannina, Codec, Luigi, Di Mauro, Giuseppe, Faccini, Marino, Gabiano, Clara, Le Serre, Daniele, Raffaldi, Irene, Margherita, Regina, Marseglia, Gianluigi, Mascolo, Amelia, Stronati, Mauro, Centis, Rosella, D'Ambrosio, Lia, Pasinato, Angela, Russo, Cristina, Scaglione, Franco, Scala, Elisabetta, Tomà, Paolo, Esposito, Susanna, Galli, Luisa, Lancella, Laura, Lo Vecchio, Andrea, Principi, Nicola, Bosis, Samantha, a Garazzino, Silvi, Villani, Alberto, Bernardi, Filippo, Assante, Luca, Codecasa, Luigi, Matteelli, Alberto, Tortoli, Enrico, Scaglione, Francesco, Cirillo, Daniela, Battista Migliori, Giovanni, Tadolini, Marina, Garazzino, Silvia, and Migliori, Giovanni Battista

Subjects
0301 basic medicine, Pediatrics, medicine.medical_specialty, Tuberculosis, Extensively Drug-Resistant Tuberculosis, 030106 microbiology, Antitubercular Agents, Pediatric tuberculosi, Anti-tuberculosis drugs, MDR-TB, Mycobacterium tuberculosi, Mycobacterium tuberculosis, 03 medical and health sciences, Therapeutic approach, Antitubercular Agent, 0302 clinical medicine, Tuberculosis, Multidrug-Resistant, Children, Pediatric tuberculosis, XDR-TB, Pharmacology, Humans, Medicine, 030212 general & internal medicine, Adverse effect, Child, Cause of death, biology, business.industry, Anti-tuberculosis drug, Extensively drug-resistant tuberculosis, medicine.disease, biology.organism_classification, Settore MED/38, Systematic review, Infectious disease (medical specialty), Extensively Drug-Resistant Tuberculosi, Practice Guidelines as Topic, business, Human
Abstract

Tuberculosis (TB) is still one of the most difficult infectious diseases to treat, and the second most frequent cause of death due to infectious disease throughout the world. The number of cases of multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB), which are characterised by high mortality rates, is increasing. The therapeutic management of children with MDR- and XDR-TB is complicated by a lack of knowledge, and the fact that many potentially useful drugs are not registered for pediatric use and there are no formulations suitable for children in the first years of life. Furthermore, most of the available drugs are burdened by major adverse events that need to be taken into account, particularly in the case of prolonged therapy. This document describes the recommendations of a group of scientific societies on the therapeutic approach to pediatric MDR- and XDR-TB. On the basis of a systematic literature review and their personal clinical experience, the experts recommend that children with active TB caused by a drug-resistant strain of Mycobacterium tuberculosis should always be referred to a specialised centre because of the complexity of patient management, the paucity of pediatric data, and the high incidence of adverse events due to second-line anti-TB treatment.

Published
2016

4. Carbapenem-resistant enterobacteriaceae infections in children: An Italian retrospective multicenter study

Author

Maurizio de Martino, Marco Vuerich, Claudia Tagliabue, Susanna Esposito, A. Loy, Luisa Galli, Laura Cursi, Manuela Prato, Carlo Scolfaro, Andrea Lo Vecchio, Sara Colombo, Carlotta Montagnani, Eugenia Bruzzese, Montagnani, Carlotta, Prato, Manuela, Scolfaro, Carlo, Colombo, Sara, Esposito, Susanna, Tagliabue, Claudia, LO VECCHIO, Andrea, Bruzzese, Eugenia, Loy, Anna, Cursi, Laura, Vuerich, Marco, De Martino, Maurizio, and Galli, Luisa

Subjects
0301 basic medicine, Male, Microbiology (medical), Pediatrics, medicine.medical_specialty, carbapenem-resistant, children, Enterobacteriaceae, 030106 microbiology, MEDLINE, Carbapenem-resistant enterobacteriaceae, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Child, Retrospective Studies, biology, Enterobacteriaceae Infections, business.industry, Infant, Retrospective cohort study, biology.organism_classification, Anti-Bacterial Agents, Infectious Diseases, Multicenter study, Carbapenems, Italy, Child, Preschool, Pediatrics, Perinatology and Child Health, Observational study, Female, business, Pediatric population
Abstract

BACKGROUND: The spread of carbapenem-resistant Enterobacteriaceae (CRE) is a health problem of major concern. CRE-related infections have significant morbidity and mortality, but data on CRE infection in pediatric population are limited. The aim of this study was to analyze epidemiologic and clinical characteristics, risk factors, therapeutic options and outcome of CRE infections in children in Italy. METHODS: We performed a retrospective, multicenter, observational study of children with confirmed CRE infection or colonization admitted between January 1, 2011, and March 1, 2014, to 7 Italian pediatric centers. RESULTS: Sixty-nine patients presenting 74 CRE infections and/or colonization were included. The most frequently isolated strain was Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Children with CRE infections had longer length of stay in hospital (P < 0.001), duration of disease (P = 0.001) and antimicrobial treatment (P < 0.001) than colonized children. Oncologic/immunosuppressive conditions are one of the factors significantly associated with a fatal outcome among children with CRE infections. CONCLUSIONS: Our study confirms that CRE infections affect mostly children with oncologic diseases and immunosuppression. Controlled studies in large cohorts are needed to evaluate the best therapeutic options and to assess further risk factors influencing outcomes and the survival of pediatric patients with infections caused by CRE.

Published
2016

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