Problems giving current second line TB drugs to children
29 January 2015. Related: Conference reports, Paediatric care, TB coinfection, World Conference on Lung Health 45th 2014.
Polly Clayden, HIV i-Base
Results from a survey presented at 45th Union World Conference on Lung Health reveal an urgent need for child appropriate formulations of second line TB drugs. [1]
Only three second-line TB drugs currently have paediatric formulations. Information is needed on how these medicines are used and the challenges with accurate dosing.
A questionnaire was designed and sent to members of the Sentinel Project on Drug Resistant Tuberculosis in July 2012 (closed end September 2012).
Grania Bridgen from MSF presented findings from the survey on behalf of colleagues from the Sentinel Project, MSF and the Treatment Action Group.
Twenty-one respondents from 13 countries, providing care for more than 400 children answered the survey.
Medications that caused the most difficulty with dosing were: cycloserine (n=7), PAS (n=5), ethionamide (n=4), ethambutol (n=3), quinalones (n=3), PZA (n=2) and terizadone (n=2).
Respondents said that problems related to the large pill burden, duration of treatment and adverse events as well as difficulties splitting adult tablets. All respondents had problems giving the current formulations. For some of the most commonly used second-line drugs there is no standardised protocol, increasing the chances of errors with dosing.
Despite modifications being made to some products – Dr Bridgen gave the example of the PAS dosing spoon – these might not reach those that need them.
The Sentinel Project is working on Target Product Profile for second-line drugs for children to help minimise delays with child appropriate formulations.
Comment
This survey highlights the practical difficulties associated with giving second-line TB drugs with children, where appropriate formulations are not usually available.
References:
- Brigden G et al. Issues administering oral second-line medications with multi-drug resistant TB (MDR-TB). 45th Union World Conference on Lung Health. Barcelona, Spain. 28 October-1 November 2014. OAP-201-30. Abstract presentations, Thursday, 30 October. S202.
http://slideonline.eu/recordings/2014/14union - The Sentinel Project on Drug Resistant Tuberculosis
http://sentinel-project.org