Controversies in preventive therapy for children contacts of multidrug-resistant tuberculosis.

BACKGROUND: Drug-resistant tuberculosis (DR-TB) is emerging as an increasing problem worldwide and no consensus has been reached about the management of children contacts of DR-TB cases. OBJECTIVE: To evaluate the role of post-exposure chemoprophylaxis in paediatric DR-TB contacts, focusing on literature findings and recommendations from existing international guidelines. METHODS: We conducted a literature search of the Cochrane Library, MEDLINE by PubMed and EMBASE from database inception through September 2012, using an appropriate search strategy. RESULTS: Eighteen articles were included: four retrospective and two prospective population studies, eight international guidelines and four narrative reviews. CONCLUSIONS: General agreement exists that preventive therapy could be beneficial in specific high-risk groups, including immunocompromised children and those aged < 5 years. However, no consensus exists on the use of preventive therapy in older or immunocompetent children and on which regimen should be preferred.