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Table of Contents   
LETTER TO THE EDITOR  
Year : 2016  |  Volume : 9  |  Issue : 4  |  Page : 293-294
Childhood tuberculosis: Administering child-friendly tuberculosis medicines in the right dosage universally


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India

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Date of Web Publication28-Jun-2016
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Childhood tuberculosis: Administering child-friendly tuberculosis medicines in the right dosage universally. Ann Trop Med Public Health 2016;9:293-4

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Childhood tuberculosis: Administering child-friendly tuberculosis medicines in the right dosage universally. Ann Trop Med Public Health [serial online] 2016 [cited 2019 Oct 13];9:293-4. Available from: http://www.atmph.org/text.asp?2016/9/4/293/184799
Dear Sir,

Tuberculosis (TB) has been identified as the world's leading infectious disease in terms of the number of deaths that can be attributed to disease related complications.[1] TB tends to affect individuals from all the age-groups, including children with almost 1 million diagnosed with TB infection, while close to 0.14 million died because of the disease worldwide in the year 2014 alone.[1] Further, the presence of TB among children precisely reflects the ongoing community transmission, and almost equivalent rates of drug resistance have been reported among children as that of adults.[1],[2]

Over the years, the diagnosis or management of childhood TB has remained quite challenging with the questionable sensitivity/utility of sputum smear microscopy in establishing the diagnosis, an indispensable need to have different drug dosages (which have remained unavailable for decades together) when compared with adult TB, and a wide gap in the practice when compared with the standard policies.[1],[2],[3] Childhood TB has been neglected for years together, and despite recommendations to increase the dosage of anti-TB drugs for children in 2010, no such alterations were made by the manufacturers due to lack of any incentives.[3]

It will not be wrong to say that till date, no children around the world had an access to appropriate TB medications.[4] In fact, even at present in almost every setting of the world, it is the responsibility of either the parent or the health care provider to approximate the correct dose for a specific child by crushing the available drugs.[2],[4] Not only this procedure is unscientific but also it gives the medicines a bitter taste and makes them unpalatable, and eventually makes it extremely difficult for children and their families to complete the entire course of therapy.[2],[4] In addition, the effectiveness of treatment is reduced and hence a negative treatment outcome is inevitable, resulting in a rise in the incidence of drug resistant TB, which is much more difficult to cure.[1],[2],[3]

Acknowledging the need to administer the correct dosage of anti-TB drugs in children, the World Health Organization (WHO) in collaboration with other international stakeholders have pledged to introduce the correct dosages of child-friendly TB medications.[3] Although, the short-term goal is to meet the dosage guidelines recommended by the WHO and to ensure that drugs are simple to administer, with a good shelf life in all climatic regions, dispersible and palatable, nevertheless, the ultimate aim is to significantly reduce the childhood TB related death rates (everyday 400 children die because of TB worldwide).[3],[4]

Owing to the efforts made by the international stakeholders in the last few years, and in the quest to end the TB epidemic by 2030, the WHO and their partners have released a newer fixed-dose combination (FDC) for children comprising isoniazid, rifampicin, and pyrazinamide.[3] Even though, these are not new drugs, but they are flavored and easily soluble, and hence, make it easier for both parents and the health care providers to administer them to children.[3],[4] Further, they enable the administration of the right medicines in the right doses, enhance the rates of treatment adherence, reduce burden on the health systems, especially in terms of requirement of lesser storage space, and bring about an improvement in the daily lives of children/families struggling to conquer TB.[3],[4] It has been planned to release the quality assured FDC to all nations from the beginning of 2016 through the Global Drug Facility.[5]

However, in order to accomplish the desired target, the current challenge is to ensure that these FDC is available in different parts of the world and, thus, there is a great need to address market barriers and to encourage pooled procurement to ensure that new treatments are accessible to children in need at an affordable price.[4],[5] Further, appropriate incentives should be given to the manufacturers of childhood TB drugs, a mechanism should be developed to enhance the coordination among all stakeholders, and special emphasis should be given toward increasing awareness about drugs among health professionals and even the patients.[3],[4],[5]

To conclude, childhood TB is a public health concern that can be definitely solved provided we choose to act in collaboration. Further, no child should succumb to TB-related complications and hence ensuring availability of newer FDC universally can enable the program managers to develop a sustainable response against childhood TB.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
World Health Organization. Global Tuberculosis Report 2015. Geneva: WHO Press; 2015. p. 1-13.  Back to cited text no. 1
    
2.
Kamath SS. Reach, treat and cure pediatric tuberculosis: Raising the voice for children. Indian Pediatr 2015;52:283-4.  Back to cited text no. 2
    
3.
World Health Organization. World's first child-friendly TB medicines in correct doses; 2015. Available from: http://who.int/tb/features_archive/FDC_formulation_launch/en/. [Last accessed on 2015 Dec 17].  Back to cited text no. 3
    
4.
Usherenko I, Basu Roy U, Mazlish S, Liu S, Benkoscki L, Coutts D, et al. Pediatric tuberculosis drug market: An insider perspective on challenges and solutions. Int J Tuberc Lung Dis 2015;19(Suppl 1): 23-31.  Back to cited text no. 4
    
5.
Scott C, Gardiner E, de Lucia A. The procurement landscape of pediatric tuberculosis treatment: A global drug facility perspective. Int J Tuberc Lung Dis 2015;19(Suppl 1):17-22.  Back to cited text no. 5
    

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Correspondence Address:
Saurabh R Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.184799

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