A new sweetened, cherry-flavoured dispersible antimalarial tablet is as effective as the crushed, currently used variety, which needs to be crushed before administration to small children, resulting in a bitter taste. Thus the new tablet could improve adherence to drug treatment and improve cure rates, and survival of children in malaria endemic regions. These are the conclusions of an Article published early Online and in an upcoming edition of The Lancet, written by Dr Salim Abdulla, Ifakara Health Institute, Dar es Salaam, Tanzania, and colleagues.
Artemether-lumefantrine became the first fixed-dose combination therapy that was prequalified by WHO in 2004, and a 3-day, six-dose regimen of the drug is safe and effective in both adults and children. However many young children cannot swallow whole tablets. And crushing tablets is an inefficient procedure — some of the drug can be lost, and, when added to water, the crushed tablets can give a bitter taste making it difficult for children to tolerate and leading to lower doses of drug ingested. The new dispersible formulation has a cherry flavor and contains the same amount of artemether (20mg) and lumefantrine (120mg) as the conventional tablet.
This randomised trial studied 899 children, of which 447 received the dispersible tablet and 452 were given the conventional, crushed tablet. More than 85% of patients in each treatment group completed the study, and 812 (403 dispersible, 409 conventional) qualified for the final analysis. The day-28 cure rate was 97.8% in the dispersible group and 98.5% in the conventional group. The most common drug-related adverse event was vomiting, which occurred in 7% of the dispersible group and 9% of the conventional group.
The authors conclude: "Since we found that the dispersible formulation was similar in efficacy and safety to the standard formulation, cost savings are also likely with its use, with the potential benefit of improving acceptability of the combination once on the market. The price of the dispersible tablets has not yet been decided but the manufacturers have indicated that it is likely to be similar to the existing formulation…The dispersible formulation is easy to administer, gives compliance and effective treatment; and hence facilitates adoption in malaria control programmes."
In an accompanying Comment, Dr Awash Teklehaimanot, Earth Institute at Columbia University, New York, USA, and Dr Haily Desta Teklehaimanot, Center for National Health Development in Ethiopia, Addis Ababa, Ethiopia, say: "The use of dispersible tablets will potentially enhance and promote better treatment outcomes and delay the development of drug resistance at the same time. The effect will be substantial because artemether-lumefantrine is currently one of the most widely used antimalarials in Africa."
Dr Salim Abdulla, Ifakara Health Institute, Dar es Salaam, Tanzania T) +255 787 744 555 E) sabdulla@ihi.or.tz
Dr Awash Teklehaimanot, Earth Institute at Columbia University, New York, USA T) + 1 212 854 8157 / +1 646 206 3479 E) at2076@columbia.edu
Full Article and Comment: http://press.thelancet.com/malariatabletfinal.pdf
Journal
The Lancet