On 14-15 July 2011, an informal consultation was convened to discuss
strategies for advancing the availability of a fixed-dose combination (FDC) medicine for treatment of
paediatric tuberculosis (TB). While the primary focus was first-line therapies, second-line treatments
were also discussed. The meeting was held at the World Health Organization (WHO) headquarters in
Geneva, coordinated by the Medicines Access and Rational Use (MAR) unit. Participants
included representatives from WHO, academic institutions, nongovernmental organizations, pharmaceutical industry associations, procurement organizations, regulatory
agencies, and funder agencies.
While FDCs exist for treating paediatric TB, the available products are based
on outdated dosing guidelines. Because these existing formulations are significantly different from
current dosing recommendations, it is too complicated to use the products as a long-term
solution. Specifically, the ratios of individual medicine components in the existing FDCs do not
correspond to those in the revised dosing recommendations. It is overly complicated, and in some cases
impossible, to use them and achieve correct dosing. Other options, such as splitting or
crushing adult strength tablets as a means of delivering correct doses, are also unrealistic as long
term solutions, particularly because of poor compliance and risk of dosing errors. Policies and
scientific evidence of the need for a revised FDC are clear, yet progress towards a revised product
has been slow...