Incidence, Management and Factors Affecting Unsuccessful Treatment Outcomes in Pediatric Multidrug-Resistant Tuberculosis Patients: A Cross-sectional Retrospective Study in Pakistan

Abstract This study examined the clinical, sociodemographic and treatment-related parameters influencing the therapeutic response to multidrug-resistant (MDR) tuberculosis (TB) treatment in pediatric patients. This multicenter retrospective cross-sectional study was conducted in the programmatic management of drug-resistant tuberculosis sites in Khyber Pakhtunkhwa, Pakistan. Basic characteristics, treatment regimens and outcomes were collected from the TB registries. Out of the 450 patients analyzed, 79.1% had successful treatment results, achieving the WHO aim of >75%. Similar to previous studies, this study reported a 5.3% death rate and a 5.6% loss to follow-up. Multivariate analysis showed that no history of prior TB treatment was significantly associated with unfavorable outcomes (adjusted OR: 3.1, 95% CI: 1.9–5.1, P < 0.001). Patients on a specific second-line longer treatment regimen (Lfx, Bdq, Cs, Lzd, Cfz, B6) had higher odds of unsuccessful outcomes (adjusted OR: 2.0, P = 0.009). Furthermore, patients on shorter treatment regimens were substantially more likely to experience unsuccessful outcomes. The study emphasizes the difficulty in treating children with MDR-TB and the importance of creating individualized treatment programs that take each patient’s medical history and resistance profile into account. Although shorter regimens and newer medications seem promising, further research is required to verify their efficacy.