title: Are age-appropriate antibiotic formulations missing from the WHO list of essential medicines for children? A comparison study.
abstract: OBJECTIVE
  There is a global call for formulations, which are better suited for children of different age categories and in a variety of settings. One key public health area of interest is age-appropriate paediatric antibiotics. We aimed to identify clinically relevant paediatric formulations of antibiotics listed on pertinent formularies that were not on the WHO Essential Medicines List for Children (EMLc).
  
  
  METHODS
  We compared four medicines lists versus the EMLc and contrasted paediatric antibiotic formulations in relation to administration routes, dosage forms and/or drug strengths. The additional formulations on comparator lists that differed from the EMLc formulations were evaluated for their added clinical values and costs.
  
  
  RESULTS
  The analysis was based on 26 EMLc antibiotics. Seven oral and two parenteral formulations were considered clinically relevant for paediatric use. Frequently quoted benefits of oral formulations included: filling the gap of unmet therapeutic needs in certain age/weight groups (phenoxymethylpenicillin and metronidazole oral liquids, and nitrofurantoin capsules), and simplified administration and supply advantages (amoxicillin dispersible tablets, clyndamycin capsules, cloxacillin tablets, and sulfamethoxazole+trimethoprim tablets). Lower doses of ampicillin and cefazolin powder for injection could simplify the dosing in newborns and infants, reduce the risk of medical errors, and decrease the waste of medicines, but may target only narrow age/weight groups.
  
  
  CONCLUSIONS
  The identified additional formulations of paediatric antibiotics on comparator lists may offer clinical benefits for low-resource settings, including simplified administration and increased dosing accuracy. The complexity of both procuring and managing multiple strengths and formulations also needs to be considered.
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.|Faculty of Medical Sciences, University "Goce Delcev-Stip," Republic of Macedonia.
authors.forename: Verica
authors.initials: V
authors.lastname: Ivanovska
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.|Medicines Evaluation Board, The Netherlands.
authors.forename: Hubert G
authors.initials: HG
authors.lastname: Leufkens
authors.affiliation: Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Carin Ma
authors.initials: CM
authors.lastname: Rademaker
authors.affiliation: Faculty of Medical Sciences, University "Goce Delcev-Stip," Republic of Macedonia.|Agency for Quality and Accreditation of Healthcare Institutions, Macedonia.
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Zisovska
authors.affiliation: Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Mariëlle W
authors.initials: MW
authors.lastname: Pijnenburg
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Liset
authors.initials: L
authors.lastname: van Dijk
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Aukje K
authors.initials: AK
authors.lastname: Mantel-Teeuwisse
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D004333:Drug Administration Routes; D004339:Drug Compounding; D018954:Drugs, Essential; D005569:Formularies as Topic; D006801:Humans; D014944:World Health Organization
chemical_list: D000900:Anti-Bacterial Agents; D018954:Drugs, Essential
keywords: antibiotics; children; developing countries; essential medicines list