E-DRUG: Stavudine in Paediatric ART? (3)
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Dear E-Druggers,
I really do not think that the STGs were reviewed because of impending donation of the FDCs as may have been suggested. In temperate countries of which Namibia is one, preservation of Stavudine solution has always been a problem as the syrup is not stable beyond 24 hours after opening without refrigeration. This has been a great challenge in resource limited settings. I am of the opinion that the coming of Stavudine based FDCs for 1st Line use should be viewed as a blessing for at least three reasons:
1. It comes in handy in children who are anemic.
2. Putting three or two ARVs in one formulation has the great potential of improving adherence in children who are not very cooperative to take the unpalatable syrups.
3. The problem of stability in the absence of the fridge is over!
There are, of course, alternatives to Stavudine for first line use when the situation warrants that but where there are no problems I am of the opinion that this should be a source of relief to some of us who have always complained that ARV and TB medicines manufacturers are not children-friendly.
The fact that these are coming as donations for now (For a year only as is the practice with Clinton Foundation, writing under correction!) does not mean that the STGs were reviewed because of that. There are other changes in the reviewed STG (using WHO's recommendations) which have nothing to do with Stavudine's FDCs. They would have still been procured anyway since they are not only cheaper but also better for the reasons mentioned above. Suffice to write here too that PEPFAR's supply chain management systems also supplies those triple FDCs which means they have received full or at least tentative FDA Approval.
For me, I am looking forward to the time when Zidovudine (AZT) based FDCs will also come-to make life easier for these poor children.
Best Regards,
Pharm. Idris, Rafiu Adeyemi
ACTS Advisor,
SCMS Namibia.
Windhoek
Namibia
idrisra@yahoo.com