Clinical outcomes of pulmonary tuberculosis two years later in children treated with daily regimen of antitubercular drugs

Background In 2017, the Revised National Tuberculosis Control Program (RNTCP), now known as the National Tuberculosis Elimination Program (NTEP), introduced a major change in its treatment guidelines, shifting from an alternate-day regimen to daily dosing to improve treatment outcomes. Studies conducted on adults indicate that there are minimal differences in treatment failure or recurrence rates between the regimens, however, patients who received three times weekly dosing throughout the therapy exhibited higher rates of acquired drug resistance.This study was undertaken due to the significant lack of available data in the literature regarding recurrence rates among pediatric patients who were undergoing daily drug regimens. Methods Children and adolescents up to 18 years old, who completed pulmonary tuberculosis treatment at least 2 years prior, were included in the study. A detailed history was asked, and old medical records and investigations were assessed. Nutritional status was assessed using anthropometric parameters. Pulmonary function tests were performed in children over 7 years old, excluding those with contraindications or inability to produce acceptable PFT graphs. Results In total, there were 165 patients divided into different age groups: 33 patients (20.0 %) were below 7 years old, 61 patients (37 %) were between 7 and 12 years, and 71 patients (43.0 %) were between 12 and 18 years of age. The gender distribution showed 61.8 % females and 38.2 % males. Around 52.6 % were underweight cases, which decreased to only 10.2 % on follow-up after completion of treatment. The recurrence rate post-treatment was 7.9 %. Urban areas showed higher recurrence rates (9.3 %) and urban slums (6.3 %) compared to rural (0 %) areas. Children with failure to gain weight had a higher recurrence rate (p = 0.001), indicating a bidirectional relationship between TB and undernutrition. The mortality rate due to TB was 2.42 %. Pulmonary function tests showed abnormalities in 9 patients(26.47 %) (19 % restrictive pattern, 7.47 % obstructive pattern)out of 34 cases who could perform spirometry. Conclusion Despite completing daily drug therapy successfully, the average recurrence rate was found to be 7.9 %. This is similar to the recurrence rate found in the studies involving adult patients treated with the thrice-weekly/alternate days regimens.