Additive manufacturing is redefining the landscape of pediatric tuberculosis (TB) treatment by enabling personalized drug delivery, improved surgical planning, and tailored educational tools. A group of researchers from Maharaja Ranjit Singh Punjab Technical University, Chitkara University, and Thincr Technologies compiled extensive evidence in a review published via ScienceDirect, highlighting how 3D printing is being used to address the clinical and pharmaceutical challenges of pediatric TB.
Unlike adult TB, pediatric cases often involve extrapulmonary presentations, making them harder to diagnose and treat. Children rarely produce sputum for standard testing, and common symptoms are frequently nonspecific. In 2020, the CDC reported 317 TB cases among U.S. children under 14. The majority affected children aged 1 to 4, with adolescents aged 10 to 14 making up another significant portion. In many countries, limited access to diagnostic infrastructure exacerbates these challenges. Researchers are now applying additive manufacturing to fabricate custom anatomical models, localized drug delivery implants, and responsive oral dosage systems to address these barriers.
One study developed oral isoniazid tablets using fused deposition modeling (FDM). These tablets offered release profiles ranging from 40 to over 800 minutes, depending on print density and polymer composition. The research team used hot-melt extruded filaments with hydroxypropyl cellulose and other pharmaceutical polymers, enabling controlled customization without altering the drug formulation itself.
Another group designed 3D printed scaffolds with truncated hexahedron structures to treat spinal TB. These scaffolds were combined with an injectable bone substitute paste made of hydroxyapatite, gelatin, and streptomycin. After application, the composite showed a compressive strength increase from 1.5 MPa to nearly 4.8 MPa and demonstrated streptomycin release between 4.9% and 6.5%—sufficient to kill TB bacteria locally. Surface analysis with scanning electron microscopy confirmed full paste integration across the porous lattice.
A functional spinal unit replacement was also fabricated using polylactic acid and acrylonitrile butadiene styrene scaffolds, embedded with hydrogels carrying rifampicin and levofloxacin. Over a 60-day in vivo study, the implants maintained mechanical strength and sustained antibiotic release while integrating with surrounding tissue. Platelet-rich plasma was incorporated to promote regeneration of intervertebral disc components.
In the diagnostic space, one team developed an inverted microscope from 3D printed components to support the MODS assay for TB culture analysis. Another project combined a portable ultraviolet fluorescence device with a 3D printed enclosure and smartphone-assisted imaging for sunrise-type SmartAmp nucleic acid detection. The system identified TB DNA at concentrations as low as 10 femtograms per microliter and delivered results within 45 minutes.
Material selection for TB drug delivery systems continues to expand. One scaffold design combined mesoporous bioactive ceramics with poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) to deliver rifampicin and isoniazid locally following osteoarticular surgery. The composite released both drugs steadily over 12 weeks, maintained tissue concentrations above therapeutic thresholds, and showed no liver or kidney toxicity. Histological analysis confirmed scaffold degradation and new bone growth at the treatment site.
A separate study addressed drug-drug interactions between isoniazid and rifampicin by printing dual-compartment bilayer tablets. Hypromellose acetate succinate was used to encapsulate rifampicin for intestinal release, while hydroxypropyl cellulose enabled immediate isoniazid release in the stomach. This physical separation preserved drug stability and improved bioavailability in combined therapy.
Another team fabricated a four-layer implant with alternating layers of isoniazid and rifampicin for staged drug release. Each compound reached peak plasma concentrations at staggered intervals between 8 and 12 days. In vivo testing confirmed that the implant was biocompatible and did not interfere with stem cell proliferation.
Printing technologies vary by application. FDM remains dominant for tablets and oral systems due to its accessibility and compatibility with pharmaceutical-grade polymers. For implants and anatomical scaffolds, selective laser sintering (SLS) and stereolithography (SLA) provide finer resolution and more complex geometries. Diagnostic devices often utilize digital light processing and SLA to create precise enclosures and functional channels for microfluidic or imaging purposes.
Material strategies also differ. Polycaprolactone, hydroxyapatite, gelatin, and composite ceramics are frequently used in structural applications. For oral drug delivery, polymers like hydroxypropyl methylcellulose and hypromellose are common due to their tunable dissolution properties. Recent studies have explored metal-organic frameworks and nanocomposites to combine mechanical strength with controlled drug release.
One drug-loaded scaffold designed for spinal TB used a ceramic bone structure coated in a triple drug mixture of delamanid, moxifloxacin, and pyrazinamide suspended in polylactic-co-glycolic acid. This device offered both structural support and targeted antibiotic delivery. Another study demonstrated that 3D printed microneedle arrays could administer rifampicin transdermally, avoiding gastrointestinal degradation and improving compliance. A hydrogel-based patch was also tested for transdermal delivery of quercetin to reduce oxidative lung damage in pulmonary TB.
Although these systems show promise, only a fraction have reached large-scale production or regulatory review. Most devices require specialized equipment and formulation expertise, and variability in printing conditions can affect reproducibility. Quality control and biocompatibility must be verified before these solutions can be broadly deployed, particularly in pediatric settings where dosage precision and safety are critical.
Despite these limitations, many groups are working to standardize printing parameters and develop protocols for clinical validation. There is growing interest in decentralized production models where hospitals or regional clinics manufacture tailored implants or tablets on-site. This would be especially beneficial in areas with limited supply chain access.
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Featured image shows Graphical abstract. Image via ScienceDirect.
