Introduction. The treatment of children with multidrug-resistant and extensively drug-resistant tuberculosis (MDR / XDR-TB) is a difficult task due to many factors: the duration of treatment, the lack of drugs with children’s dosages, age restrictions (according to the drug instructions).Purpose of the study. To assess the efficacy and safety of regimen with the inclusion of bedaquiline in children and adolescent with respiratory tuberculosis with drug-resistant tuberculosis.Materials and methods. The study is prospective, cohort, non-comparative from the period 2017–2019. We included 24 patients aged 5 to 17 years with MDR-TB (established or suspected) began regimen containing bedaquiline for 24 weeks. The duration of observation of patients included in the study was 24 months.Results. We can state a sufficient level of safety of using the latter for 24 weeks: adverse events presumably associated directly with the intake of bedaquiline were noted in only 1 patient out of 24 (4.2%; 95% CI 0.7-20.3). The efficacy of a regimen containing bedaquiline in combination with other anti-tuberculosis reserve drugs is beyond doubt: positive clinical and radiological dynamics and cessation of bacterial excretion by the end of the 24-week course of treatment were noted in all patients included in the study. In the course of 2-year follow-up, no exacerbation of the tuberculous process was observed in any case. All patients achieved clinical cure of tuberculosis.Conclusion. Regimen containing bedaquiline for children aged 5–17 years with multidrug-resistant tuberculosis is effective and safe.

Today, tuberculosis (TB) remains an urgent global public healthcare challenge. According to WHO estimates, about 1.3 million child population under age 15 fell ill with tuberculosis worldwide in 2023. An estimated 166 thousand children (0–14 years of age) died for this period. The TB incidence in children and adolescents is an important prognostic indicator that reflects the overall epidemiological situation in the region. A timely detection of the health condition, when the risk of developing active TB disease becomes the highest is an important factor for the reduction of the TB incidence. The implementation of preventive measures, including preventive treatment, will be quite effective in preventing development of TB disease. In the Russian Federation, different immunological diagnostic tests are used for preventing and early detection of TB in children according to their age. That has led to a significant reduction in the incidence in not only the child and adolescent population, but also a decrease in indices in the age group of 18-25 years. An intradermal ATP test and/or alternative in vitro tests such as IGRA tests are used, among other things, as part of diagnostic and differential diagnostic measures when tuberculosis is suspected. The use of a combination of all available methods to establish an accurate diagnosis would be appropriate in the most complex diagnostic cases. The presented clinical observation highlights a rare case of calcifying fibrous tumour in a 17-year-old boy, which required a multifaceted diagnostic approach, including modern IGRA tests (TigraTest®TB), to exclude tuberculosis involving multiple systems and select the correct treatment and diagnostic strategy to verify the diagnosis.

Use of Bedaquiline in children is studied relatively rarely therefore, according to the WHO experts, it is necessary to further conduct the research on the effectiveness and safety of including of the Bedaquiline drug in chemotherapy regimens in children as well as to obtain the new data on the characteristics of its metabolism in routine clinical practice. The purpose of this research was to evaluate the therapeutic monitoring performance of the Bedaquiline drug use in treatment of pediatric patients with multidrug-resistant tuberculosis (TB). Materials and methods used: pharmacokinetic (PK) parameters were determined in 10 patients of both genders aged 6 to 17 y/o who had received Bedaquiline drug as part of complex therapy in the treatment regimen for multidrug-resistant TB (MDR-TB). All patients had not received anti-tuberculosis drugs previously. Results: during the period of initial daily administration (saturation) of the Bedaquiline drug, Cmax was 3901 ng/ml, Cmin 165 ng/ml, Me 1672 (781.7-2562.3; 95% CI) ng/ml. During the period of maintenance dose intake (3 times per week) prior to taking the drug, Cmax was 987 ng/ml, Cmin 251 ng/ml, Me 504 (340.2-667.7; 95% CI) ng/ml, two hours after Bedaquiline intake Cmax was 2387 ng/ml, Cmin 576 ng/ml, Me 1429 (1005.9-1852.1; 95% CI) ng/ml. Conclusion: the data obtained coincide with the bibliographical data on the Bedaquiline PK in children aged 5 to 8 y/o issues.

The possibility of reducing the frequency, duration, and severity of acute respiratory infections (ARI) during the epidemic season in children with tuberculosis is an important component of a comprehensive approach to the treatment of the disease and its favorable outcome. In this regard, the anti-inflammatory drug ammonium glycyrrhizinate is of particular practical interest, as it has a successful experience of use during the ARI epidemic season in the pediatric patient population. Patients and methods. We observed 2 groups of patients (main (n = 44) and control (n = 32)) aged 3–17 years with various forms of respiratory tuberculosis during the ARI epidemic season. Patients in the main group, in addition to baseline therapy for the underlying disease, were prescribed ammonium glycyrrhizinate for 60 days. On days 1, 15, 30, 45, and 60 of observation, physical examination was performed; cases and duration of ARI, the volume of additionally required therapy, and cases of adverse reactions associated with the study drug were recorded. ARI symptoms were assessed using a 4-point scale. Results. Among patients receiving ammonium glycyrrhizinate, the frequency of ARI was recorded more than 2 times lower compared to the control group (15.9% vs 34.4%); 9.4% of children in the control group had ARI twice, while no recurrent ARI episodes were noted in the main group. The average duration of ARI in the main group was 3 days – 40% less compared to the control group (5 [4; 8] days, p = 0.008). In the group of patients receiving ammonium glycyrrhizinate, compared to the control group, ARI episodes occurred with a lower frequency of symptoms of weakness (40% vs 90%, p = 0.04), decreased appetite (6.7% vs 63.6%, p = 0.003), headache (13.3% vs 54.5%, p = 0.003); the duration of fever was significantly shorter (Me 2 [1; 2] vs 3 [3; 5] days (p = 0.014)). Regarding respiratory symptoms, the main group showed a tendency towards a higher frequency of daytime cough (40% vs 18.2%) along with a lower frequency of sputum (6.7% vs 27.3%) and nighttime cough (6.7% vs 9.1%), which was associated with the mucoregulatory effect of the drug. The mean score for weakness and decreased appetite in the main group was 0.5 ± 0.3 and 0.14 ± 0.01 points, respectively; in the control group, these symptoms were significantly more intense – 1.9 ± 0.7 and 1.3 ± 0.5 points, respectively (p < 0.05). Conclusion. The obtained results demonstrate the efficacy and safety of administering ammonium glycyrrhizinate to patients with respiratory tuberculosis during the ARI epidemic season in addition to baseline anti-tuberculosis therapy in order to reduce the frequency, duration, and intensity of ARI symptoms. Key words: children, tuberculosis, acute respiratory infection, ammonium glycyrrhizinate, cough, intoxication

The objective: to study detection and clinical and radiological characteristics of tuberculosis in children and adolescents with malignant diseases. Subjects and Methods. Medical records of 105 children with respiratory tuberculosis (RTB) aged from 6 months to 17 years inclusive, examined in 2018–2025, were analyzed. Children were divided into two groups: Main Group (MG) – children with respiratory tuberculosis (RTB) and malignant neoplasms (MN) (52 patients) and Control Group (CG) – children with RTB and no MN (53 patients). Demographic characteristics, features of clinical manifestations and forms of respiratory tuberculosis of the patients were retrospectively analyzed. Results. In 73.1% (38/52) of cases, respiratory tuberculosis in children from MG was detected during the onset of malignant neoplasms or their treatment, in 17.3% (9/52) – at the stage of malignant neoplasm remission, in 9.6% – at the stage of post-tuberculosis changes in the form of calcifications in the intrathoracic lymph nodes prior to development of malignant neoplasms. In MG, tuberculosis was detected in 59.6% (31/52) of patients with hemoblastoses and 40.4% (21/52) of patients with malignant neoplasms of solid organs. In children from MG, tuberculosis was detected in 21.2% (11/52) of cases based on the results of immunodiagnostics and in 78.8% (41/52) when they referred for help with complaints. In children from MG, the course of respiratory tuberculosis was characterized by a widespread disease (78.8%, 41/52) and development of bronchopulmonary complications (80.8%, 42/52). Among children with hemoblastoses, generalized or disseminated forms of tuberculosis were in 32.3% (10/31) of cases, in children with malignant neoplasms of solid organs – in 9.5% (2/21). The incidence of lesions of central nervous system in children from MG made 7.7% (4/52).

Parasitic infections are widespread throughout the world and are especially common in childhood. The absence of pathognomonic symptoms in liver diseases is characteristic. We presented clinical observation with asymptomatic echinococcosis with damage to the respiratory organs and liver. During the fluorographic examination, changes in the lungs were revealed, in connection with which she was sent for a consultation with a phthisiatrician. In the TB hospital, with the help of a comprehensive examination and modern telemedicine technologies, changes were identified in lungs and in the liver. This clinical observation showed that it is necessary to conduct a comprehensive examination before prescribing specific anti-tuberculosis treatment. Increasing physicians' knowledge of parasitic diseases could increase the early detection.