儿童结核病药物治疗现状及进展

Current Status and Progress of Drug Treatment for Pediatric Tuberculosis

摘要: 儿童结核病是严重危害儿童健康的全球性公共卫生问题，全球结核病的负担中14岁及以下儿童占11%。近年来，儿童结核病药物治疗领域取得了突破性进展，尤以耐药结核病治疗方案的革新最为显著。在儿童药代动力学研究方面，全球范围内的系统综述和荟萃分析为优化儿童给药剂量提供了重要依据。然而，儿童重症结核病(如结核性脑膜炎、粟粒性结核)的治疗仍是临床难点，药物血脑屏障穿透性不足、缺乏高质量循证证据等问题需要深入研究。此外，儿童结核病药物研究也面临挑战，包括低龄儿童的剂量安全性数据不足、结核性脑膜炎等重症形式的药物穿透性问题，以及超短程方案需要进一步验证。本文系统综述近5年儿童结核病药物研究的主要进展，包括新药研发、方案优化、药代动力学研究、制剂开发和安全性数据，并对未来研究方向提出展望。

Abstract: Pediatric tuberculosis is a global public health problem that seriously endangers children’s health, with children aged 14 years and under accounting for 11% of the global tuberculosis burden. In recent years, breakthrough progress has been made in the field of drug therapy for pediatric tuberculosis, particularly in the innovation of treatment regimens for drug-resistant tuberculosis. In the area of pediatric pharmacokinetics, systematic reviews and meta-analyses conducted worldwide have provided important evidence for optimizing drug dosing in children. The treatment of severe tuberculosis in children, such as tuberculous meningitis and miliary tuberculosis, remains a clinical challenge due to poor drug penetration across the blood-brain barrier and lack of high-quality evidence. In addition, research on pediatric tuberculosis drugs still faces challenges, including insufficient safety and dosing data in young children, issues related to drug penetration in severe forms such as tuberculous meningitis, and the need for further validation of ultra-short-course regimens. This article systematically reviews the major research advances in pediatric tuberculosis drugs over the past five years, covering new drug development, regimen optimization, pharmacokinetic studies, formulation development, and safety data, and provides perspectives on future research directions.