Paediatric Tuberculosis: What Is New?

Background: India carries the highest global burden of tuberculosis (TB), with children contributing approximately 6%-7% of cases reported under the National Tuberculosis Elimination Programme (NTEP). Paediatric TB poses unique diagnostic and therapeutic challenges due to its paucibacillary nature, difficulty in specimen collection and increasing prevalence of drug-resistant TB. Recent advances in diagnostics, therapeutics and preventive strategies have transformed the management of TB in children. Methods: This narrative review summarises recent evidence, World Health Organisation (WHO) recommendations and updated NTEP guidelines on the diagnosis, treatment and prevention of TB in children. Literature was identified from WHO reports, national programme guidelines and recent peer-reviewed studies focusing on molecular diagnostics, drug-resistant TB regimens and TB preventive treatment (TPT). Results: Rapid molecular diagnostics such as Xpert MTB/RIF, Truenat assays, Xpert MTB/XDR and line probe assays allow early detection of TB and drug resistance. Use of less invasive specimens, including stool and nasopharyngeal aspirates, is upcoming. The C-Tb skin test is a newer diagnostic tool for the detection of latent TB with greater specificity than the tuberculin skin test (TST). Treatment outcomes have improved with newer drugs such as bedaquiline and delamanid, and short-duration all-oral regimens for drug-resistant TB. Shorter rifamycin-based TPT regimens have enhanced adherence and completion rates. Conclusion: Recent advances in diagnostics, treatment and prevention have significantly improved the management of paediatric TB. Integration of rapid molecular testing, child-friendly all-oral regimens and shorter preventive therapies can improve outcomes and support India’s efforts towards TB elimination.