Chiappini E, Matucci T, Lisi C, et al. - By retrospectively reviewing the 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 related to the use of SLDs in children with and without documented drug-resistant forms of tuberculosis (DR-TB). There were 204 children diagnosed with active TB during the study period; due to confirmed or likely drug resistance, adverse reactions to first-line drugs, involvement of central nervous system, or possible drug resistance that was not confirmed, 42 were treated with SLDs. There have been no reports of death or adverse reactions related to SLDs. In 85.2% of children treated with first-line drugs and 92.9% treated with SLDs, treatment was successful. The only factor linked to DR-TB was < 2 years old, after adjusting for the calendar period. TB at 2 or more sites, extrapulmonary TB or adverse reactions to first-line drugs were factors linked to treatment with SLDs. No variations in age or region of origin were observed. Findings suggested that SLDs have treated a substantial proportion of TB children. A high success rate and a good tolerability profile were related to the use of SLD regimens.