Pediatric tuberculosis is an underappreciated global epidemic estimated to afflict around
half a million children worldwide. This problem has historically been overlooked, due in part to their
low social status and the difficulty in diagnosis of tuberculosis in children. Children are more
susceptible to tuberculosis infection and disease progression, including rapid dissemination into extrapulmonary
infection sites. Treatment of pediatric tuberculosis infections has been traditionally built
around agents used to treat the adult disease, but the disease pathology, drug pharmacokinetics and the
safety window in children differs from the adult disease. This produces additional concerns for drug discovery and
development of new agents. This review examines: (i) the safety concerns for current front and second line agents used to
treat complex drug resistant infections and how this knowledge can be used to identify, prioritize and dose agents that
may be better tolerated in pediatric populations; and (ii) the chemistry and suitability of new drugs in the clinical
development pipeline for tuberculosis for the treatment of pediatric infections indicating several new agents may offer
significant improvements for the treatment of multi-drug resistant tuberculosis in children.
Keywords: Pediatric tuberculosis, Tuberculosis, tuberculosis drug discovery.
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