E-DRUG: Co-trimoxazole prophylaxis for HIV in children
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Dear e-druggers,
I wanted to share some thoughts with you on the above subject and to seek
views/comments. I am seeing an increasing number of requests for
paediatric co-trimoxazole syrup from countries, in the context of
prophylaxis. This is probably not unrelated to publication of the results
of the double-blind randomized placebo-controlled CHAP study by Chintu et
al (November 2004), and the subsequent Joint WHO/UNAIDS/UNICEF statement on
"Use of Co-trimoxazole as Prophylaxis in HIV Exposed and HIV infected
Children". It is always a good sign when basic and applied research
blossoms into policy and then on to practice!
However, I have been reflecting on the possible technical consequences of
this particular opportunity, based on the fact that, generally, the most
common formulation in the field for this product is "powder/granules for
reconstitution". Most manufacturers, if not all, recommend that once
reconstituted the product must be discarded after about one week. This is
understandable, for a treatment course. The CHAP study used 5ml and 10ml
syrup daily for children <5yrs and > 5yrs respectively, This would mean
that for children <5 yrs, use of the smallest pack size I have seen (60ml)
should last between 10-12 days, i.e. outside the recommended range of QA.
This obviously has potential economic and clinical risks. Is this only an
imagined problem? I would very much appreciate the views of colleagues
who are face-to-face with reality on the front line - in clinic and
household settings.
If on the other hand the problem can be real, then we should be doing
something about how to deal with it, either through the promotion of the
use of pre formulated syrups which tend to be more stable in use but are
logistically more complicated to deal with, or doing further work on
improving the stability of co-trimoxazole powder for reconstitution. This
medicine is a time-tried technology which has worked, so we should not take
lightly any smoldering risks to its continued value in infection
management.
Murtada M. Sesay
Technical Officer (Pharmaceuticals)
UNICEF Supply Division
Tel: +45 3527 3098
Mobile: +45 28 23 28 07
E-mail: msesay@unicef.org
Web: www.unicef.org/supply