Childhood tuberculosis treatment remains challenging due to issues with accurately diagnosing and dosing children. While guidelines recommend increasing medication dosages for children, they fail to address how to improve diagnostic accuracy and develop child-specific drug formulations tailored to a child's age and size. More research is needed to develop methods to better diagnose and treat tuberculosis in children.

1. news
Childhood tuberculosis treatment remains imprecise science
Last year, the World Health Organization in part have to do with the thought that children profit margins in addressing the problem and
released updated procedures on how best to with the illness are less infectious than affected have not made significant investments in this
tackle the global scourge of tuberculosis. The adults, so disease control programs tend to area. Graham suggests that a solution is to give
fourth edition of the “Treatment of tuberculosis: focus on older populations capable of spreading drug developers “the assurance that they would
Guidelines” recommended, among other the pathogen within their communities. have a market.”
changes, increasing the dosage of tuberculosis But, in certain regions of the world with In addition, clinical trials for children need
medication required to treat children. But, in a high rates of the disease, “the average risk of to be implemented so that child-specific
sense, the new guidance provided a destination [childhood infection] is about 20% per year of formulations can move forward. “Companies
without a map: it failed to address the larger life in the first five years, so this is not a minor are doing the studies in the adults and forgetting
problem of how to improve the accuracy of component that can be easily overlooked,” about the kids, and meanwhile all these
pediatric dosing. says Tobias Kollmann, a pediatric infectious children die,” says Grace Aldrovandi, a pediatric
In recent months, researchers have pointed to disease specialist at the University of British infectious disease researcher at the University of
a host of problems plaguing the diagnosis and Columbia in Vancouver, Canada. “It’s a huge Southern California–Los Angeles.
treatment of tuberculosis in children, especially growing problem in areas where tuberculosis A handful of developers are bucking the
those younger than age 5. For example, at a June is resurgent.” trend. The German drug giant Bayer is
workshop held by a taskforce of the US Centers Current tuberculosis medications are currently testing its antibacterial drug Avelox
for Disease Control and Prevention, Steve comprised of a single, fixed-dose combination (moxifloxacin) in a 2,400-adult phase 3 clinical
© 2011 Nature America, Inc. All rights reserved.
Graham of the Royal Children’s Hospital in tablet that combines a number of drugs. As trial for tuberculosis that could potentially
Melbourne, Australia called for new and better Graham cautioned in a paper published in be suitable for children. If the drug proves
means of pediatric tuberculosis diagnosis, March, the ratios of those medications should effective for grownups, it may be in safety trials
which can be complicated by concurrent also vary according to a child’s age and size, in children by 2014, says Elizabeth Gardiner,
ailments such as malnourishment, HIV an issue that is also not addressed in the new head of market access for the New York-
infection and pneumonia. And, in September, guidelines (Paediatr. Respir. Rev. 12, 22–26, based TB Alliance, which is cosponsoring the
scientists noted that a negative result from the 2011). Currently, to treat small children the international study. The US pharmaceutical
new interferon-gamma release assays cannot adult tablets are cut or crushed, which often company Janssen Therapeutics in is in the
definitively rule out tuberculosis in children leads to inaccurate dosing and inappropriate early stages of developing a child-specific
(Pediatr. Infect. Dis. J. 30, 817–818, 2011). Also ratios. tuberculosis treatment called TMC207 and is
in September, another group urged that animal To avoid these issues, experts say weight- in discussions with The IMPAACT Network,
models for tuberculosis “must be designed and adjusted tablets or a liquid formulation need a clinical trials group, to begin trials with
utilized in a manner that is also pertinent to the to be developed specifically for children, so children.
pediatric population” by addressing age-related that treatments can be more easily tailored. “We’re on the verge of real change when it
variance in drug metabolism (Pharmacol Res. But, despite the fact that an estimated 1 million comes to pediatric tuberculosis,” Gardiner says,
64, 176–179, 2011). children currently suffer from tuberculosis, “and we hope that it really happens.”
If pediatric tuberculosis is overlooked, it may pharmaceutical companies do not see huge Julie Manoharan
NIH student training overhauled after HHMI pulls funding
As an undergraduate student at the Institutes of Health (NIH) and the Howard programs with a new education initiative
University of Wisconsin–Madison, Amanda Hughes Medical Institute (HHMI). that, at least initially, will only offer around
Herzog worked in a number of different She succeeded and became one of the half the number of spots that were previously
research laboratories, where she studied 42 students chosen from hundreds of available.
everything from cartilage growth to applicants for the program’s 2010–2011 HHMI has funded the Research Scholars
pediatric tonsillectomy techniques to fruit academic year. As an HHMI-NIH Research Program—also known as the Cloister Program
fly behavior. So, when she started medical Scholar, she was able to defer her third because the participants are housed in an
school at UW’s School of Medicine and year of medical school and instead study old convent on the NIH campus—since its
Public Health in 2007, she figured she’d an experimental head and neck cancer inception in 1985. But the goal all along
keep up with her research activities. Yet, drug in cellular and animal models at the had been simply to help get the program off
other than a three-month stint assisting NIH in Bethesda, Maryland. the ground, notes William Galey, director of
oncologist Mark Albertini in his melanoma For Herzog, the experience was a first graduate science education programs for the
lab for a summer research program step to fulfilling her budding career Chevy Chase, Maryland–based nonprofit.
between her first and second years, Herzog ambitions. “I would love to have my A quarter-century later, with that mission
has struggled to fit research into her own lab down the road,” she says, “and accomplished, HHMI decided to pull its
schedule. “I had to devote my time to my this program will help me get my foot support and invest in other training efforts,
studies,” she says. in the door.” But other aspiring medical such as its international student research
Herzog’s passion for lab work inspired researchers might not be so lucky. On fellowships, offered for the first time this
her to apply for a unique research 30 August, the NIH announced plans year. “It was really time to hand the keys over
program funded jointly by the US National to replace its existing medical training to the NIH,” Galey says.
1160 volume 17 | number 10 | october 2011 nature medicine