Chiappini E, Matucci T, Lisi C, et al. - Via retrospectively reviewing medical records of pediatric tuberculosis (TB) patients referred to a center in Italy from 2007 to 2018, researchers characterized the treatment of pediatric TB with second-line drugs (SLDs) and factors correlated with use of SLDs in children with and without documented drug-resistant forms of tuberculosis (DR-TB). Of 204 children diagnosed with active TB during the study period, 42 were treated with SLDs due to confirmed or likely drug resistance, adverse reactions to first-line drugs, the involvement of the central nervous system or possible drug resistance that was not confirmed. In 85.2% of children treated with first-line drugs and 92.9% of children treated with SLDs, treatment was successful. The only factor associated with DR-TB was < 2 years old after adjusting for calendar period. TB at two or more sites, extrapulmonary TB or adverse reactions to first-line drugs were factors associated with treatment with SLDs. There were no differences in age or region of origin. The data presented in this work showed a substantial proportion of TB children have been treated with SLDs. The primary reason for using SLDs was a first-line drug regimen failure, indicating possible DR-TB and childhood underestimation of DR-TB. A high success rate and good tolerability profile were associated with the use of SLD regimens. There have been no reports of death or adverse reactions to SLDs.