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Introduction of

Child-Friendly
TB Medicines
Cherise Scott
TB Alliance
15 December 2015
CNS Webinar

Childhood TB: Hiding in the shadows


Children with TB are the neglected of the neglected
TB is a significant cause of death among
children; children are susceptible to the most
severe and fatal forms of TB

In 2014, an estimated 1 million children


became ill with TB and 140, 000 children died
of TB, according to the WHO.
Children with TB have been historically
neglected many go undiagnosed and
untreated
Child health and survival is improving, with
fewer deaths from diseases such as HIV and
pneumonia. But TB lingers, and lacks
attention and resources dedicated to the
problem
Introduction of Child-Friendly TB Medicines

New guidelines, old drugs


Market unresponsive to call for new treatments

In 2010, WHO revised dosing guidelines for TB drugs for children based on
evidence that children were not receiving enough TB medicine
Drug

Previous WHO Guidance

Current WHO Guidance

Dose and range (mg/kg


body weight)

Dose and range (mg/kg body


weight)

Isoniazid

5 (4-6)

10 (7-15)

Rifampicin

10 (8-12)

15 (10-20)

Pyrazinamide

25 (20-30)

35 (30-40)

Ethambutol*

20 (15-25)

20 (15-25)

*depending on setting and type of disease

The guidance and policy changed, but the products available for treatment of
children did not change
Many providers must crush or chop available tablets to achieve desired dose
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Challenges of administering treatment


Delivering current treatment is complex and burdensome

Dosing chart for pediatric TB


therapy in the Philippines.
Treatment administered via syrups.

Dosing chart for pediatric TB therapy


in South Africa. Treatment
administered via pills.

Introduction of Child-Friendly TB Medicines

Pharmacist preparing syrups of


Rifampicin for pediatric TB treatment
in Thailand.

Sub-optimal treatment for children


Lack of consideration of the unique needs of children

No appropriately-dosed, qualityassured, child-friendly TB medicines


Many providers must cut or crush
tablets, create their own syrups, to
achieve desired dose
Burdensome for the caregiver to
give and the child to take; decreases
adherence
Poor tasting medicine can cause
vomiting

Inconsistent administration from


country to country means there is
no unified response to the problem
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Milestone: Introduction of child-friendly FDCs


The FDCs include:
Rifampicin 75 mg + Isoniazid 50 mg
+ Pyrazinamide 150 mg (twomonth intensive phase)
Rifampicin 75 mg + Isoniazid 50 mg
(four-month continuation phase)
Product attributes:
Correct, WHO-recommended doses
Dispersible in liquid
No crushing or chopping pills

Palatable fruit flavors

Introduction of Child-Friendly TB Medicines

Impact of improved TB treatments for children


The right medicines in the right dose improves
adherence and will save more lives. This is an
important step in improving TB treatment and child
survival, and decreasing the development of drugresistant TB.
Simple formulations decrease burden on the healthcare
system and enable scale up in treatment. Simpler TB
medicines for children can allow healthcare systems to
scale up treatment. Fewer pills will simplify ordering and
storage.
Child-friendly medicines improve the lives of children
with TB and their families. Six months is a long time to
take medicine. Medicines designed for children lessen the
daily struggle of parents, caregivers, and children alike.

Improve treatment, save lives


Child-friendly TB medicines
in the correct doses are
now available

Now that improved


treatments are
available, countries
must accelerate
adoption to save lives
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How can we avoid repeating the same mistakes?


Must scale investment
in pediatric research
(including accelerating
R&D for children)
Call to Action
increase awareness,
political will, resources

One day of treatment for a child with MDR-TB/HIV


(excluding injections)
Photo credit: Desmond Tutu TB Centre

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Project Funders
We thank the funders who made this possible

Major supporter

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Sign the Call to Action:


tballiance.org/signthecall