title: Paediatric formulations of second-line anti-tuberculosis medications: challenges and considerations.
abstract: There is a growing number of children worldwide accessing second-line anti-tuberculosis drugs for multidrug-resistant tuberculosis (TB); however, there are very few child-friendly formulations. For paediatric use, dispersible tablets offer distinct advantages over liquid formulations and other approaches. This is particularly relevant for TB, where stability, long shelf-life and reduced manufacturing, transport and storage costs are all critical to ensuring that drugs are accessible and affordable. In addition, fixed-dose combinations that reduce the pill burden and provide adequate taste masking may promote long-term adherence to anti-tuberculosis treatment and prevention regimens likely to last many months in children. Partial adherence may result in treatment failure and the further selection and spread of resistant mycobacteria. Unfortunately, no second-line TB paediatric drugs exist in dispersible formulations. We discuss here the main obstacles to developing such tablets and present strategies for overcoming them. We also advocate for timely anticipation of paediatric use when new TB drugs are being developed, and for the development of child-friendly anti-tuberculosis formulations in general.
authors.affiliation: The Global Alliance for TB Drug Development, New York, New York, USA.
authors.forename: R
authors.initials: R
authors.lastname: Taneja
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: A J
authors.initials: AJ
authors.lastname: Garcia-Prats
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Furin
authors.affiliation: Macleods Pharmaceuticals Ltd, Mumbai, India.
authors.forename: H K
authors.initials: HK
authors.lastname: Maheshwari
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage*; D002626:Chemistry, Pharmaceutical / Q000191:economics*; D002648:Child; D006801:Humans; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents