Perspective

1 million child-friendly TB courses ordered since 2016

Mel Spigelman 2019
Mel Spigelman

Approximately 1 million treatment courses of new tuberculosis medicines designed for easy administration in children have been ordered by 93 countries since they were first introduced in 2016, according to the nonprofit organization TB Alliance.

“Strategic investments in TB treatment for children have corrected a dire market failure and enabled the rapid, widespread introduction of child-friendly TB medicines around the world,” Mel Spigelman, MD, president and CEO of TB Alliance, told Infectious Diseases in Children.

WHO estimates that 1 million children are diagnosed with TB every year, and more than 230,000 of these children die.

Children with TB undergoing treatment often experience adherence difficulties, treatment failure or death. The regimens are the first to meet WHO guidelines for childhood TB treatment, according to a TB Alliance press release.

A boy in Delhi holds up improved TB medicines for children 
A boy in Delhi holds up the improved TB medicines for children.
Source: John-Michael Maas for TB Alliance

The medicines were first introduced in Kenya, which, along with the other 92 countries procuring the treatment, account for 75% of the estimated global childhood TB burden, according to the release.

“The vast majority of countries that are heavily impacted by TB now have access to child-friendly TB medicines that are in the WHO recommended doses,” Spigelman said. “There is no longer a need to approximate children’s dosing by crushing or splitting bitter-tasting adult pills. They are also dispersible in water and flavored for palatability, which makes it easier for caregivers and parents to administer to children.” – by Joe Gramigna

Reference:

WHO. Global Tuberculosis Report 2018. https://www.who.int/tb/publications/global_report/en. Accessed June 17, 2019.

Disclosures: Spigelman is president and CEO of TB Alliance. The company reports funding from Unitaid, Australian Aid, Irish Aid, USAID and UK Aid.

Mel Spigelman 2019
Mel Spigelman

Approximately 1 million treatment courses of new tuberculosis medicines designed for easy administration in children have been ordered by 93 countries since they were first introduced in 2016, according to the nonprofit organization TB Alliance.

“Strategic investments in TB treatment for children have corrected a dire market failure and enabled the rapid, widespread introduction of child-friendly TB medicines around the world,” Mel Spigelman, MD, president and CEO of TB Alliance, told Infectious Diseases in Children.

WHO estimates that 1 million children are diagnosed with TB every year, and more than 230,000 of these children die.

Children with TB undergoing treatment often experience adherence difficulties, treatment failure or death. The regimens are the first to meet WHO guidelines for childhood TB treatment, according to a TB Alliance press release.

A boy in Delhi holds up improved TB medicines for children 
A boy in Delhi holds up the improved TB medicines for children.
Source: John-Michael Maas for TB Alliance

The medicines were first introduced in Kenya, which, along with the other 92 countries procuring the treatment, account for 75% of the estimated global childhood TB burden, according to the release.

“The vast majority of countries that are heavily impacted by TB now have access to child-friendly TB medicines that are in the WHO recommended doses,” Spigelman said. “There is no longer a need to approximate children’s dosing by crushing or splitting bitter-tasting adult pills. They are also dispersible in water and flavored for palatability, which makes it easier for caregivers and parents to administer to children.” – by Joe Gramigna

Reference:

WHO. Global Tuberculosis Report 2018. https://www.who.int/tb/publications/global_report/en. Accessed June 17, 2019.

Disclosures: Spigelman is president and CEO of TB Alliance. The company reports funding from Unitaid, Australian Aid, Irish Aid, USAID and UK Aid.

    Perspective
    Jeffrey R. Starke

    Jeffrey R. Starke

    The ordering by 93 countries of 1 million treatment courses of child-friendly TB medications formulated as dispersible fixed-dose combinations of drugs is a wonderful milestone in the effort to end childhood TB. As noted in the announcement, caregivers have had to cut or crush bitter-tasting pills formulated for adults, combine incorrectly dosed formulations and make up jury-rigged suspensions for which there are no pharmacokinetic data. I have always respected greatly the parents and other caregivers for children with TB for their diligence and creativity in getting the children to take the medications. There is no doubt that these new formulations will improve treatment throughout most of the world. Ironically, because of issues with licensing and procedures, one of the countries where these new formulations are not available and won’t be in the foreseeable future is the United States.

    As important as this milestone is, its significance requires some perspective. WHO now estimates that there are 1 million annual cases of childhood TB and 234,000 annual deaths caused by the disease. The 1 million treatment courses over 3 years will, at best, reach less than a third of the children with TB. Previous modeling estimates indicate that over 90% of children who die from TB receive no treatment, and the estimated mortality rate of 23% is not different from the estimated rate in the pre-chemotherapy era. Having child-friendly formulations is a necessary element of ending childhood TB but will do little good if we do not improve our ability and willingness to find, correctly diagnose and treat children with the disease.

    Reference:

    Dodd PJ, et al. Lancet Glob Health. 2017;doi:10.1016/S2214-109X(17)30289-9.

    • Jeffrey R. Starke, MD
    • Professor of pediatrics
      Baylor College of Medicine
      Infectious Diseases in Children Editorial Board member