New pneu­mo­nia drug prom­ises hope for chil­dren

Amoxyl DT is cheaper, more ef­fec­tive and eas­ier to store and ad­min­is­ter than the older medicine

Business Daily (Kenya) - - FRONT PAGE - Stel­lar Mu­rumba smu­rumba@ke.na­tion­media.com

In­tro­duc­tion ofamoxyl DT — a cheaper and more ef­fec­tive op­tion — could bring re­lief to fam­i­lies fac­ing huge costs to treat the dis­ease

Treat­ment of pneu­mo­nia in chil­dren has been prob­lem­atic in Kenya for a long time due to costly but largely in­ef­fec­tive syrup medicines.

The in­tro­duc­tion of Amox­i­cillin Dis­persible Tablets (Amoxyl DT) — a cheaper and more ef­fec­tive op­tion — into the lo­cal mar­ket could how­ever bring re­lief to fam­i­lies fac­ing huge costs to treat the dis­ease.

Dr Warfa Os­man, the Head of the Neona­tal, Child and Ado­les­cent Health Unit at the Health min­istry, said the drug — which was in­tro­duced in the coun­try for the first time last Mon­day — would help curb deaths.

“Amoxyl DT dis­solves in liq­uid and dis­in­te­grates within three min­utes when put in wa­ter or in a small amount of breast milk be­fore ad­min­is­tra­tion to al­low for uni­form dif­fu­sion, mak­ing it more ef­fec­tive,” Dr Os­man told the

“It is also cheaper. A pack of 100 tablets will cost Sh145, at­trib­ut­able to the lower ship­ping and stor­age costs.” An orig­i­nal Amoxyl syrup 50ml costs up­wards of Sh400.

The Health min­istry, on rec­om­men­da­tions of the World Health Or­gan­i­sa­tion (WHO), has re­vised its treat­ment guide­lines to in­clude the child-friendly Amoxyl DT as a first line treat­ment for pneu­mo­nia in chil­dren.

The United Na­tions Chil­dren’s Fund (Unicef ) in­tro­duced Amoxyl DT in its sup­ply cat­a­logue in 2011. The drug has been avail­able in other coun­tries but re­mained low in many low-and mid­dle-in­come coun­tries in­clud­ing Kenya.

This is de­spite a Unicef re­port show­ing that 60 per cent of the over 1.2 mil­lion pneu­mo­nia deaths in un­der-five-year-olds glob­ally oc­curs in 10 coun­tries; Kenya, Uganda, Tan­za­nia, Bangladesh, DR Congo, Ethiopia, In­dia, Niger, Nige­ria and Pak­istan. About 19,000 Kenyan chil- dren die ev­ery year from pneu­mo­nia, trans­lat­ing to one death in ev­ery 20 sec­onds.

Pneu­mo­nia — a form of acute res­pi­ra­tory in­fec­tion that af­fects lungs — is the num­ber one killer of chil­dren un­der the age of five years and ac­counts for 16 per cent of deaths in Kenya and 18 per cent glob­ally. “In or­der to fur­ther in­crease ac­ces­si­bil­ity and use of Amoxyl DT, ad­vo­cacy ef­forts are re­quired to sup­port changes to na­tional treat­ment guide­lines and in­clu­sion in the na­tional es­sen­tial medicines list,” the re­port says.

“De­spite af­ford­able di­ag­nos­tics and in­ex­pen­sive an­tibi­otics avail­abil­ity, only a third of pneu­mo­nia cases re­ceive an­tibi­otics as part of their treat­ment reg­i­mens.”

The re­port fur­ther says that health­care work­ers face dif­fi­culty ad­min­is­ter­ing ap­pro­pri­ate drug dosages to chil­dren.

Pae­di­atric for­mu­la­tions are of­ten ap­prox­i­mated by break­ing up adult doses.

“For in­stance, tablets are of­ten cut, crushed and then mixed into a liq­uid; con­cen­trated cap­sules are di­luted; or in­jecta­bles are taken orally. Th­ese adap­ta­tions com­pro­mise ef­fec­tive­ness,” says the re­port

Amoxyl DT re­places the Amoxyl syrup, which doc­tors say is cum­ber­some to dis­pense as the spoon size used in ad­min­is­ter­ing could change dosage ac-

cu­racy. “Un­like the syrup which re­quires re­frig­er­a­tion in high tem­per­a­tures, Amoxyl DT does not re­quire re­frig­er­a­tion and is easy to dis­pense thus con­ve­nient dos­ing,” said Dr Os­man.

Pneu­mo­nia presents it­self as a cough with fast breath­ing, fever, wheez­ing and draw­ing in of the chest.

A child with pneu­mo­nia would be un­able to eat or drink and may ex­pe­ri­ence un­con­scious­ness, hy­pother­mia and con­vul­sions if treat­ment is not given im­me­di­ately.

Pneu­mo­nia dis­lodged malaria in 2015 to be­come the top killer of Kenyans with deaths from HIV, tu­ber­cu­lo­sis (TB) and menin­gi­tis de­clin­ing.

Of­fi­cial data shows that pneu­mo­nia killed 22,473 Kenyans in 2015, up from 21,640 the pre­vi­ous year, while ca­su­al­ties from malaria — which has for years been the top killer — de­clined by 2,267 to 20,691 in the same pe­riod.

Data from the Min­istry of Health shows chil­dren in western Kenya are more likely to die from pneu­mo­nia com­pared to other parts of the coun­try due to high preva­lence of malaria, di­ar­rhoea and un­der­ly­ing causes such as mal­nu­tri­tion and HIV/AIDS. “Nyanza re­gion has the high­est un­der-five mor­tal­ity rate at 82/1,000 live births fol­lowed by Nairobi at 72/1,000 live births,” said Dr Os­man.

The new drug has many ad­van­tages over the syrup and could go a long way in fight­ing pneu­mo­nia, he said.

Amoxyl DT also in­creases pa­tient com­pli­ance as it re­duces wastage through spillage and does not re­quire re­frig­er­a­tion as com­pared to the syrup.

It is also eas­ily stored and trans­ported, at­tract­ing less ship­ping and stor­age costs hence en­cour­ag­ing sup­ply.

“Amoxyl DT has a more con­ve­nient dos­ing sched­ule as it is ad­min­is­tered only two times a day com­pared to the syrup — four times a day — thus en- courag­ing bet­ter com­pli­ance,” said Dr Os­man.

“It is also pain-free and re­duces gen­eral health costs as there is no need for in­jec­tion sy­ringes.”

Dr Os­man said the min­istry in­tro­duced the pneu­mo­coc­cal vac­cine (PCV10) for pre­ven­tion and now Amoxyl DT as treat­ment.

The Kenya De­mo­graphic Health Sur­vey (2014) shows that the up­take of PCV10 is at 85 per cent.

It is im­por­tant for a child to re­ceive all three doses of PCV10 vac­cines be­fore the age of one year — at six, 10 and 14 weeks.

Pneu­mo­coc­cal vac­cine pro­tects against se­vere forms of pneu­mo­coc­cal dis­eases such as menin­gi­tis, pneu­mo­nia and bac­ter­aemia, ac­cord­ing to Dr Os­man.

FOTOSEARCH

DEADLY Right: An in­fected lung.

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