Global sales of oral antibiotics formulated for children

Abstract

Objective To investigate international consumption patterns of child-appropriate oral formulations of antibiotics by formulation type, with a focus on dispersible tablets, using data from a global sales database. Method Antibiotic sales data for 2015 covering 74 countries and regional country groups were obtained from the MIDAS ® pharmaceutical sales database, which includes samples of pharmacy wholesalers and retailers. The focus was on sales of child-appropriate oral formulations of Access antibiotics in the 2017 World Health Organization’s WHO Model list of essential medicines for children . Sales volumes are expressed using a standard unit (i.e. one tablet, capsule, ampoule or vial or 5 mL of liquid). Sales were analysed by antibiotic, WHO region and antibiotic formulation. Findings Globally, 17.7 billion standard units of child-appropriate oral antibiotic formulations were sold in 2015, representing 24% of total antibiotic sales of 74.4 billion units (both oral and parenteral) in the database. The top five child-appropriate Access antibiotics by sales volume were amoxicillin, amoxicillin with clavulanic acid, trimethoprim–sulfamethoxazole, cefalexin and ampicillin. The proportion of the top five sold for use as a syrup varied between 42% and 99%. Dispersible tablets represented only 22% of all child-appropriate oral formulation sales and made up only 15% of sales of 10 selected Access antibiotics on the model list for children. Conclusion Globally most child-appropriate oral antibiotics were not sold as dispersible tablets in 2015, as recommended by WHO. There is a clear need for novel solid forms of antibiotics suitable for use in children.

Collaborative partnerships as a solution for poor access to essential antimicrobial medicines: what can we learn from the chlorhexidine gel example?

“…The user-friendliness of formulations is too often neglected in paediatric medicine. Many oral formulations are not age-appropriate12 and sales of age-appropriate oral antibiotics are limited 13. In some LMICs, packaging and dosing devices are insufficiently regulated; we observed elsewhere, during ongoing research, the absence of dosing devices for liquid oral formulations and absence of instructions for reconstitution.…”

“…Many oral formulations are not age-appropriate 12 and sales of age-appropriate oral antibiotics are limited. 13 In some LMICs, packaging and dosing devices are insufficiently regulated; we observed elsewhere, during ongoing research, the absence of dosing devices for liquid oral formulations and absence of instructions for reconstitution. Global partnerships aiming to improve access to paediatric antimicrobials should act on the whole product lifecycle, including these neglected aspects.…”

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