In a special initiative launched in 2022, JJ Hospital has provided bedaquiline treatment to 29 children. Among them, four who were afflicted with pre-XDR-TB have successfully recovered.
Tragically, one child passed away due to complications from the illness. However, the majority of the children undergoing treatment are showing promising progress. In India, bedaquiline, hailed as a significant advancement in TB medication, is exclusively administered to children aged five and above.
According to a report of TOI, The four children who recovered were between 4 months and 4 years old when treatment commenced. “We have shared this development with the Central TB division, and hope for the gradual extension of the drug’s usage to more institutes for younger patients, said Dr Sushant Mane, JJ’s nodal officer for paediatrics at National Centre for Excellence for TB. He said 10 children are being treated with bedaquiline alongside other drugs, while 19 are receiving a combination of bedaquiline and delamanid.
The primary advantage of bedaquiline lies in its ability to circumvent the use of injectable medications like amikacin, which are not only painful but also associated with severe side effects such as hearing loss. Dr. Mane said, "With bedaquiline, these children can follow an all-oral regimen, eliminating the necessity for injections." This enables the substitution of daily injectables that children typically endure for 4-6 months during their 18-month course of treatment for drug-resistant TB. Doctors noted that the only notable side effect observed was skin discoloration, which may or may not be permanent.
Among the four children who have successfully recovered, only one had TB affecting the lungs, while the remaining three presented with extra-pulmonary TB symptoms such as swollen lymph nodes, fever, and weight loss upon admission to the hospital. Additionally, two of these children had at least one adult family member diagnosed with TB. Dr. Mane underscored the crucial role of drugs like bedaquiline in saving the lives of infants who face daunting odds against drug-resistant TB.
In 2022, WHO paved the way for the use of bedaquiline and delamanid in children of all ages. However, India has exercised caution due to the limited availability of pediatric data. While the national TB program has recently approved the use of delamanid for children of all ages, a decision regarding the implementation of bedaquiline for younger children is still pending.