Effectiveness of Bedaquiline-, Delamanid- and Linezolid-Containing Regimens in Improving Treatment Outcomes Among Pediatric and Adolescents With Drug-Resistant Tuberculosis in the Country of Georgia

BACKGROUND: Formulating effective regimens to treat children with drug-resistant tuberculosis (TB) remains a great challenge. We aimed to compare treatment outcomes among children treated with regimens containing newer second-line anti-TB drugs to those treated with previously used regimens. METHODS: We conducted a retrospective cohort study of individuals ≤18 years old treated for rifampicin-resistantTB in the country of Georgia from 2009 to 2023. We defined "new and repurposed second-line drugs (SLDs)" as regimens that contained bedaquiline, delamanid and/or linezolid; otherwise categorized as "traditional SLDs." We defined poor end-of-treatment outcomes if participants were lost to follow-up, experienced treatment failure or died during treatment. We defined poor long-term outcomes as TB recurrence and/or all-cause mortality after TB treatment completion. We reported relative risks and 95% confidence intervals (CIs) estimated with multivariable log-binomial regression models. RESULTS: We included 158 children and adolescents; 51 (32%) received new and repurposed SLDs and 107 (68%) received traditional SLDs. Poor end-of-treatment outcome was much less common among those who received new and repurposed SLDs compared with those who received traditional SLDs [1 (2%) vs. 18 (18%); adjusted risk ratio, 0.11 (95% CI, 0.01-0.50)]. Poor long-term outcomes occurred among 7 (4%) participants, including 4 [3% (95% CI, 0.8-6.0)] who had recurrent TB (2 received traditional SLDs and 2 received new and repurposed SLDs) and 3 [2% (95% CI, 0.5-5.1)] who died after TB treatment completion (all received traditional SLDs). CONCLUSIONS: Children and adolescents treated for rifampicin-resistant TB with new and repurposed drugs had much better treatment outcomes than those treated with traditional SLDs.