Malaria’s bitter pill made sweeter for children

Studies in five African countries have shown that a new sweetened formulation of an antimalarial that can be dissolved in water is just as effective as the crushed standard tablet.

It is hoped that the new formulation will make children more likely to finish a course of antimalarials.

The study, carried out in Benin, Kenya, Mali, Mozambique and Tanzania, was published online in The Lancet this month (15 October).

The researchers randomly assigned nearly 900 children under 12 years to receive either crushed artemether-lumefantrine dissolved in water or the new cherry-flavoured artemether-lumefantrine which is specifically designed to disperse in water

They found that the cherry-flavoured formulation was just as effective at treating malaria.

Caregivers often crush the conventional pill and mix it with water to make it easier for small children to swallow. But the crushing risks weakening the dosage, and children often spit out the bitter pill, even when crushed, says co-author Issaka Sagara of Mali’s Malaria Research and Training Centre at the University of Bamako.

Their rejection of the drug makes it difficult to assess dosage and renders treatment less effective. It also increases the possibility of drug-resistant strains of the parasite evolving, because only a small part of the correct dose is swallowed.

The sweeter medication makes it simpler for adults to administer doses to children, lead author Salim Abdulla from the Ifakara Health Institute in Tanzania, told SciDev.Net.

"Children prefer the cherry-flavoured medication and this improves the effective treatment of malaria," says Abdulla. "This medication [like the current malaria medication] is expected to be widely available in the public sector."

Once the study is reviewed and the flavoured drug approved by regulatory authorities, it will be distributed to children in malaria-endemic countries, says Bernhards Ogutu, a principal researcher at the Kenya Medical Research Institute and a contributor to the study. The formulation is expected to cost the same as existing malaria pills.

Ogutu says it is important to have child-friendly medication because of the potential frequency of treatment — children may have two or three episodes a year.

In an accompanying comment article in The Lancet, Hailay Desta Teklehaimanot of Ethiopia’s Center for National Health Development says the impact of the research will be ”substantial” because it improves ”one of the most widely used antimalarials in Africa".

Link to summary in The Lancet