Treating children suffering from malaria

Dr Jane Achan, Makerere University, Kampala, Uganda

Children under the age of 5 continue to be the main victims of malaria. Yet with the exception of Coartem® Dispersible, developed under the Novartis/MMV partnership, few antimalarial medicines have been specifically formulated to provide this vulnerable group with age and weight-appropriate doses in a palatable form. MMV aims to address this imbalance.

Every new MMV-sponsored medicine developed is followed by a formulation specifically tailored to meet the needs of children. For example, child-friendly formulations of the recently approved Eurartesim® and Pyramax®, are under development and due to be submitted for the same stringent approval as their parent medicines over the next 2 years.

As once-a-day therapies, Eurartesim and Pyramax might be easier to use than the twice-a-day medicines currently available. Additionally, Eurartesim provides better and longer protection from new malaria infections than other ACTs1 and Pyramax is the first ACT to be approved for the treatment of the blood-stage of both P. falciparum and P. vivax malaria.

1. Can you describe a typical experience with a malarial child in your clinic?

For any patient that comes into our facility the initial objective is to distinguish whether they have severe or uncomplicated malaria. We send a blood sample to the lab for testing. For uncomplicated malaria we treat with ACTs. For severe malaria we currently use intravenous quinine, but are in the process of changing to artesunate injection. However, there are many settings in Uganda where there is simply no access to diagnostic tests.

2. What is the advantage of a child-friendly formulation like Coartem Dispersible?

Certainly, the administration of the treatment is a lot easier. I remember how it used to be with the adult version, you had to cut it and then crush it for the child. With Coartem Dispersible it’s easy to use and children do not have to struggle to take the medicine. You can rest assured that they will receive the treatment they need even when at home.

3. What are the remaining unmet needs in terms of treating children suffering from malaria?

The dispersible formulation has indeed solved the problem of compliance and drug administration. But I think in settings like Uganda where there is a high burden of malaria, there is a need for medicines that provide a longer period of post-treatment prophylaxis. This would help reduce the burden of disease.

4. Why is it important to have a range of antimalarial medicines tailored to children’s needs?

The burden of malaria is really in children. This is the group that receives the bulk of malaria treatment. In the long term, if there are any problems with drug resistance it is children who will be most affected. So there is a need for new molecules with different mechanisms of action to address the long-term treatment needs particularly for children.

Dr Jane Achan is a paediatrician at Makerere University College of Health Sciences, Uganda.

1. Valecha N et al. ‘‘An open-label, randomised study of dihydroartemisinin-piperaquine versus artesunatemefloquine for falciparum malaria in Asia’’. PLoS One. 5(7):e11880 (2010).