WHO essential medicines for children 2011-2019: age-appropriateness of enteral formulations

Introduction The WHO Essential Medicine List for children (EMLc) is used for promoting access to medicines.The age-appropriateness of enteral (oral and rectal) formulations for children depend on their adaptability/flexibility to allow age-related or weight-related doses to be administered/prescribed and the child's ability to swallow, as appropriate. There is scant information on the age-appropriateness of essential enteral medicines for children. Objective To evaluate the age-appropriateness of enteral essential medicines. Materials and methods Age-appropriateness of all enteral formulations indicated and recommended in the EMLc 3rd to 7th (2011-2019) editions were determined by assessing swallowability and/or dose adaptability for children under 12 years, stratified into five age groups. Results Enteral formulations in the EMLc were more age-appropriate for older children aged 6-11 years than for younger children. In the 3rd edition, for older children, 77%, n=342, of formulations were age-appropriate. For younger children, age-appropriateness decreased with age group: 34% in those aged 3-5 years, 30% in those aged 1-2 years, 22% among those aged 28 days to 11 months and 15% in those aged 0-27 days. Overall, similar proportions were found for the 7th edition. In contrast, the majority of medicines in the 7th list were age-appropriate in targeted diseases like HIV and tuberculosis. Conclusion Most recommended enteral essential medicines in EMLc 2011 and 2019 were not age-appropriate for children <6 years. Medicines which are not age-appropriate must be manipulated before administration, leading to potential issues of safety and efficacy. Evaluation of the age-appropriateness of formulations for medicines to be included in EMLc could improve access to better medicines for children in the future.

Automated summary

The study found that enteral formulations in the WHO Essential Medicine List for children were more age-appropriate for older children (6-11 years old) than for younger children. Only a small proportion of formulations were considered age-appropriate for children under 6 years old. However, medications for targeted diseases like HIV and tuberculosis were mostly age-appropriate in the list.