Rethinking the packaging of Amoxicillin– Worldwide
Pneumonia is the leading cause of under-five child mortality globally, accounting for an estimated 1.1 million child deaths each year (WHO, 2013). UNICEF’s innovation project sought to investigate how Amoxicillin could be packaged to match the recommended course of treatment and thus, simplify the administration of the antibiotics to children.
Pneumonia is the leading cause of under-five child mortality globally, accounting for 18 per cent (an estimated 1.1 million) of all deaths of children under five years, which is more than AIDS, malaria and tuberculosis combined (WHO, 2013). One of the Millennium Development Goals is to reduce child mortality by addressing the main causes of child deaths (WHO, 2013). Although child deaths have numerous causes, the majority are preventable. Research and experience have shown that almost 11 million children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as vaccines, antibiotics, micronutrient supplementation, long lasting insecticidal bed nets and improved family care and breastfeeding practices. To achieve this goal, UNICEF seeks to improve health care practices and optimal management of childhood illnesses. With regard to pneumonia, providing health care supplies that optimally treat pneumonia in children could save the lives of up to 1.56 million children over five years (UNICEF).
Pneumonia accounts for 18 per cent of all deaths of children under five years globally, which is more than AIDS, malaria and tuberculosis combined.
(WHO, 2013)
Health care supplies that optimally treat pneumonia could save the lives of up to 1.56 million children over 5 years.
(UNICEF)
The problem
In 2011, WHO updated its recommendation for the treatment of pneumonia in community and replaced Co-trimoxazole with Amoxicillin (preferably in dispersible format) as the new first-line treatment for childhood pneumonia (WHO, 2011). Amoxicillin 250mg dispersible tablets (DT), scored is the most suitable format to treat childhood pneumonia in the community setup and especially in remote areas where there is no reliable sources of clean water and electricity. It is also cheaper and easier to store and to transport tablets compared storage and transportation of bottles of amoxicillin oral suspensions.
The community administration of oral amoxicillin 250mg DT in children under the age of five is either 10 or 20 tablets per treatment (given twice daily for 5 days) depends on the age and weight of the child. However, despite the availability of these inexpensive antibiotics, only a third of children with suspected pneumonia receive antibiotics as part of their treatment regimens.
In most countries, amoxicillin is prescribed and dispensed by medically qualified personnel. However, to improve access in the community, some countries allow low skilled community health workers to prescribe and dispense amoxicillin to treat childhood pneumonia in community case management set ups that integrate treatment of malaria, pneumonia and diarrhoea.
To adequately support community health workers in dispense amoxicillin accurately, the product packages of amoxicillin must therefore match the treatment guidelines outlined for children within certain age and weight ranges as presented by WHO guidelines 2011. Without amoxicillin DT in appropriate packages and instructions, community health workers face difficulties in administering the appropriate dosages to children and engage in practices that proxy the paediatric formulations of oral suspension (OS), such as breaking adult formulations and/or changing their method of administration. For instance, hard tablets are often cut, crushed and then mixed into a liquid; concentrated capsules are diluted; or injectable medications are taken orally (Every Woman Every Child, 2013).