title: Current status of the clinical development and implementation of paediatric artemisinin combination therapies in Sub-Saharan Africa.
abstract: Timely treatment of infected children with artemisinin based combination therapies is an essential tool for the effective control and potential elimination of malaria. Until recently only tablet formulations have been available for the treatment of children leading to problems of swallowability, palatability and dosing. In consequence, paediatric drug formulations of artemisinin-based combination therapy (ACT) have been developed, showing a clinically significant improvement of tolerability in young children and of their implementation is an increasingly important public health issue. In this mini-review, we focus on the recent development of paediatric ACTs and their use in practice. Paediatric ACTs are formulated as syrup, powder for suspension, dispersible tablets and granules. Overall, the use of paediatric formulation results in an improved management of clinical malaria in young children. To date, only two paediatric ACTs have been certified with WHO prequalification status as an internationally accepted quality standard. Many more paediatric ACTs are available and in use in sub-Saharan Africa despite a lack of publicly available evidence from stringent clinical development programs. The conduct of effectiveness studies to support the introduction of paediatric ACTs in official treatment recommendations is crucial in the global strategy of malaria elimination and quality assurance of available products is a public health priority.
authors.affiliation: Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
authors.forename: Selidji Todagbe
authors.initials: ST
authors.lastname: Agnandji
authors.forename: Florian
authors.initials: F
authors.lastname: Kurth
authors.forename: Sabine
authors.initials: S
authors.lastname: Bélard
authors.forename: Ghyslain
authors.initials: G
authors.lastname: Mombo-Ngoma
authors.forename: Arti
authors.initials: A
authors.lastname: Basra
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Fernandes
authors.forename: Solange Solmeheim
authors.initials: SS
authors.lastname: Soulanoudjingar
authors.forename: Akim Ayola
authors.initials: AA
authors.lastname: Adegnika
authors.forename: Michael
authors.initials: M
authors.lastname: Ramharter
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000138:chemical synthesis; D000962:Antimalarials / Q000008:administration & dosage; D037621:Artemisinins / Q000008:administration & dosage* / Q000138:chemical synthesis; D002648:Child; D004339:Drug Compounding / Q000379:methods; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000517:prevention & control*; D008297:Male
chemical_list: D000890:Anti-Infective Agents; D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin