Jawahar, M S and Sivasubramanian, S and Vijayan, V K and Ramakrishnan, C V and Paramasivan, C N and Selvakumar, Vanaja and Paul , Sare and Tripathy, S P and Prabhakar, R
(1990)
Short course chemotherapy for tuberculous lymphadenitis in
children.
British Medical Journal, 301 (6748).
pp. 359-362.
ISSN 1756-1833
Abstract
Objective-To assess the efficacy of a short
course chemotherapy regimen for treating tuberculosis
of the lymph nodes in children.
Design-Open, collaborative, outpatient clinical
trial.
Setting-Outpatient department of the Tuberculosis
Research Centre, paediatric surgery departments
of the Institute of Child Health and Hospital
for Children and the Government Stanley Hospital,
Madras, South India.
Patients-Children aged 1-12 years with extensive,
multiple site, superficial tuberculous lymphadenitis
confirmed by biopsy (histopathology or culture).
Interventions-Patients were treated with a fully
supervised intermittent chemotherapy regimen
consisting of streptomycin, rifampicin, isoniazid,
and pyrazinamide three times a week for two months
followed by streptomycin and isoniazid twice a week
for four months on an outpatient basis. Surgery
was limited to biopsy of nodes for diagnosis and
assessment.
Main outcome measures-Response to chemotherapy
was assessed by regression of lymph nodes
and healing of sinuses and abscesses during treatment
and follow up. Compliance with treatment and
frequency of adverse reactions were also estimated.
Results- 197 Patients were admitted to the study
and 168 into the analysis. The regimen was well
tolerated and compliance was good with 101 (60%)
patients receiving the prescribed chemotherapy
within 15 days of the stipulated period of six months.
Those whose chemotherapy extended beyond that
period received the same total number of doses.
Clinical response was favourable in most patients at
the end of treatment. Sinuses and abscesses healed
rapidly. Residual lymphadenopathy (exceeding 10
mm diameter) was present in 50 (30%) patients at the
end of treatment; these nodes were biopsied. Fresh
nodes, increase in size of nodes, and sinuses and
abscesses occurred both during treatment and
follow up. After 36 months of follow up after
treatment only 5 (3%) patients required retreatment
for tuberculosis.
Conclusion-Tuberculous lymphadenitis in
children can be successfully treated with a short
course chemotherapy regimen of six months.
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