[e-drug] Paediatric formulations for malaria drugs

["FH Jansen" <fhjansen@skynet.be>]

E-DRUG: Paediatric formulations for malaria drugs
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[With this posting we intend to stimulate the discussion on improving access to a range of paediatric malaria drugs, not on promoting defined producers or their products. HH, E-drug moderator].


Dear E-druggers, dear Dr Barasa Edwine,

Your remarks are correct. Paediatric formulations do not come as readily as others. And when it comes to combination therapy for malaria serious problems may occur. Artemether lumefantrine tablets for adults need to be crushed and then given to young and very sick children. 

Fortunately the private sector has found answers for your problem. 
The Belgian pharmaceutical company Dafra Pharma introduced a suspension for children containing artemether-lumefantrine(to be made up ex tempore). It comes as a dry powder and after adding water it is a sweet suspension that children like. 

For serious and complicated malaria the same company offers artemether in oil for injection. The unit dose is 20 mg/ml and permits easy calculation. 
For conditions where parenteral artemether cannot be used, e.g. in rural and remote areas where mothers have to take direct care of their children the company offers soft gel capsules containing artemether in oil for rectal application. These applications allow for rapid absorbtion from the rectum, giving peak plasma levels within 3-4 hours. When the child recovers from the initial attack therapy can then be switched to a commonly used ACT combination therapy.  

It should be noted that the suspension artemether/lumefantrine and the injectable artemether 20 mg/ml is in the running to be accepted as Essential Drug (see coverage of the discussion on WHO web site). Unfortunately the decision to accept these drugs has yet not been taken.

Sincerely yours,

Dr. F.H. Jansen
Turnhout
Belgium