Dione Benjumea-Bedoya, Jaime Alberto Robledo-Restrepo, Maria Patricia Arbelaez-Montoya, Andres Felipe Estupiñán-Bohorquez, Vanessa Sofia Sabella-Jimenez, Andrea Victoria Restrepo-Gouzy, Claudia Patricia Beltran-Arroyave, Jairo Bedoya-Giraldo, Jurg Niederbacher-Velasquez, Isabel Cristina Hurtado-Palacios, Lina Marcela Cadavid-Álvarez, Dora Elena Vanegas-Rojas, Maribel Murillo Tenorio, Lizeth Paniagua-Saldarriaga, Anibal Vicente Arteaga-Noriega, Javier M Sierra, Claudia Marcela Vélez, Jorge Humberto Botero-Garcés, Fernando Nicolas Montes-Zuluaga, Esteban Villegas-Arbelaez, David Castaño-Osorio, Victor Hugo Andrade-Agudelo, Lina Maria Pedraza-Moreno, Oscar Andrés Cruz-Martínez, Claudia Llerena-Polo, Andrea Juliana Gómez, Monica Gil-Artunduaga, María Lucia Cataño, Ivan D Florez
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引用次数: 0
Abstract
Introduction: The available clinical practice guidelines on tuberculosis infection are not exclusive to the pediatric population.
Objective: To formulate evidence-based recommendations for the evaluation, treatment, and follow-up of children in contact with patients with pulmonary tuberculosis in Colombia.
Methods: A multidisciplinary development panel (composed by clinical and field experts, researchers, and methodologists who declared conflicts of interests), including patient representatives, and decision-makers formulated 10 questions and prioritized outcomes related to diagnosis (clinical evaluation, chest X-ray, and interferon-gamma release assays-IGRA), treatment (efficacy of regimens in different clinical scenarios), and follow-up (monitoring and strategies to increase adherence) for children exposed to tuberculosis. We conducted systematic literature reviews to identify guidelines, systematic reviews, and primary studies. We assessed these sources' quality and risk of bias with specific tools. We synthesized the evidence narratively and, in some cases, performed de novo meta-analyses (diagnostic and network meta-analyses). We evaluated the certainty of evidence using the GRADE system. We used the GRADE evidence-to-recommendation framework to formulate the recommendations.
Results: We recommend 1) the use of IGRA tests to identify tuberculosis infection and chest X-rays to screen for active tuberculosis in children exposed to tuberculosis, 2) short instead of extended regimens for children with and without immunosuppression, 3) levofloxacin or susceptibility-guided regimens in cases of contact with drug-resistant tuberculosis, 4) monthly clinical follow-up during the treatment, 5) the implementation of comprehensive approaches to identify barriers to encourage treatment adherence.
Conclusions: The guideline panel provides context-specific, evidence-based recommendations for assessing and treating children exposed to tuberculosis in Colombia.
期刊介绍：
Colombia Médica is an international peer-reviewed medical journal that will consider any original contribution that advances or illuminates medical science or practice, or that educates to the journal''s’ readers.The journal is owned by a non-profit organization, Universidad del Valle, and serves the scientific community strictly following the International Committee of Medical Journal Editors (ICMJE) and the World Association of Medical Editors (WAME) recommendations of policies on publication ethics policies for medical journals.
Colombia Médica publishes original research articles, viewpoints and reviews in all areas of medical science and clinical practice. However, Colombia Médica gives the highest priority to papers on general and internal medicine, public health and primary health care.
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