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Antiparasitic drugs for paediatrics: systematic review, formulations, pharmacokinetics, safety, efficacy and implications for control

  • JENNIFER KEISER (a1) (a2), KATRIN INGRAM (a1) (a2) and JÜRG UTZINGER (a2) (a3)
  • DOI:
  • Published online: 24 February 2011

Drug development for paediatric applications entails a number of challenges, such as the wide age spectrum covered – from birth to adolescence – and developmental changes in physiology during biological maturation that influence the efficacy and toxicity of drugs. Safe and efficacious antiparasitic drugs for children are of pivotal importance given the large proportion of burden attributable to parasitic diseases in this age group, and growing efforts to administer, as widely as possible, antiparasitic drugs to at-risk populations, such as infants and school-aged children, often without prior diagnosis. The purpose of this review is to investigate whether antiparasitic drugs have been adequately studied for use in paediatrics. We approached this issue through a systematic review using PubMed and the Cochrane Central Register of Trials covering a period of 10 years and 8 months until the end of August 2010 to identify trials that investigated efficacy, safety and pharmacokinetic (PK) parameters of antiparasitic drugs for paediatrics. Overall, 269 clinical drug trials and 17 PK studies met our inclusion criteria. Antimalarial drugs were the most commonly studied medicines (82·6%). Most trials were carried out in Africa and children aged 2–11 years were the age group most often investigated. Additionally, we critically examined available drug formulations for anthelminthics and identified a number of shortcomings that are discussed. Finally, we shed new light on current proposals to expand ‘preventive chemotherapy’ to preschool-aged children and emphasise that new research, including risk-benefit analyses, are needed before such a strategy can be adopted more widely.

Corresponding author
*Corresponding author: Jennifer Keiser, Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, P.O. Box, CH–4002 Basel, Switzerland. Tel.: +4161 284-8218. Fax: +41 61 284-8105. E-mail:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

J. J. Aponte , D. Schellenberg , A. Egan , A. Breckenridge , I. Carneiro , J. Critchley , I. Danquah , A. Dodoo , R. Kobbe , B. Lell , J. May , Z. Premji , S. Sanz , E. Sevene , R. Soulaymani-Becheikh , P. Winstanley , S. Adjei , S. Anemana , D. Chandramohan , S. Issifou , F. Mockenhaupt , S. Owusu-Agyei , B. Greenwood , M. P. Grobusch , P. G. Kremsner , E. Macete , H. Mshinda , R. D. Newman , L. Slutsker , M. Tanner , P. Alonso and C. Menendez (2009). Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials. Lancet 374, 15331542.

J. Bethony , S. Brooker , M. Albonico , S. M. Geiger , A. Loukas , D. Diemert and P. J. Hotez (2006). Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet 367, 15211532.

M. Betson , J. C. Sousa-Figueiredo , C. Rowell , N. B. Kabatereine and J. R. Stothard (2010). Intestinal schistosomiasis in mothers and young children in Uganda: investigation of field-applicable markers of bowel morbidity. American Journal of Tropical Medicine and Hygiene 83, 10481055.

R. E. Black , S. Cousens , H. L. Johnson , J. E. Lawn , I. Rudan , D. G. Bassani , P. Jha , H. Campbell , Fischer Walker , C. , R. Cibulskis , T. Eisele , L. Liu , C. Mathers , Child Health Epidemiology Reference Group of WHO and UNICEF (2010). Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375, 19691987.

I. Boots , R. N. Sukhai , R. H. Klein , R. A. Holl , J. M. Wit , A. F. Cohen and J. Burggraaf (2007). Stimulation programs for pediatric drug research – do children really benefit? European Journal of Pediatrics 166, 849855.

K. M. Bosompem , I. A. Bentum , J. Otchere , W. K. Anyan , C. A. Brown , Y. Osada , S. Takeo , S. Kojima and N. Ohta (2004). Infant schistosomiasis in Ghana: a survey in an irrigation community. Tropical Medicine and International Health 9, 917922.

J. Breitkreutz (2009). Dosage forms for children. After the EU Reform. Pharmazie unserer Zeit 38, 3037.

J. Breitkreutz and J. Boos (2007). Paediatric and geriatric drug delivery. Expert Opinion on Drug Delivery 4, 3745.

I. Choonara (2009). Ethical and safety aspects of clinical trials in neonates. Early Human Development 85, S1920.

J. Cohen , M. S. Dibner and A. Wilson (2010). Development of and access to products for neglected diseases. PLoS One 5, e10610.

S. Conroy , J. McIntyre , I. Choonara and T. Stephenson (2000). Drug trials in children: problems and the way forward. British Journal Clinical Pharmacology 49, 9397.

L. M. Fox (2006). Ivermectin: uses and impact 20 years on. Current Opinion in Infectious Diseases 19, 588593.

A. Garba , N. Barkire , A. Djibo , M. S. Lamine , B. Sofo , A. N. Gouvras , E. Bosque-Oliva , J. P. Webster , J. R. Stothard , J. Utzinger and A. Fenwick (2010). Schistosomiasis in infants and preschool-aged children: infection in a single Schistosoma haematobium and a mixed S. haematobium-S. mansoni foci of Niger. Acta Tropica 115, 212219.

T. G. Geary , K. Woo , J. S. McCarthy , C. D. Mackenzie , J. Horton , R. K. Prichard , N. R. de Silva , P. L. Olliaro , J. K. Lazdins-Helds , D. A. Engels and D. A. Bundy (2010). Unresolved issues in anthelmintic pharmacology for helminthiases of humans. International Journal for Parasitology 40, 113.

R. D. Gosling , M. E. Cairns , R. M. Chico and D. Chandramohan (2010). Intermittent preventive treatment against malaria: an update. Expert Reviews of Anti-Infective Therapy 8, 589606.

P. J. Hotez , D. Engels , A. Fenwick and L. Savioli (2010). Africa is desperate for praziquantel. Lancet 376, 496498.

R. C. Howie (2011). Blood sample volumes in child health research: review of safe limits. Bulletin of the World Health Organization 89, 4653.

P. J. Hotez , D. H. Molyneux , A. Fenwick , J. Kumaresan , S. Ehrlich Sachs , J. D. Sachs and L. Savioli (2007). Control of neglected tropical diseases. New England Journal of Medicine 357, 10181027.

M. Kastner , N. L. Wilczynski , C. Walker-Dilks , K. A. McKibbon and B. Haynes (2006). Age-specific search strategies for Medline. Journal of Medical Internet Research 8, e25.

O. Kayser , C. Olbrich , S. L. Croft and A. F. Kiderlen (2003). Formulation and biopharmaceutical issues in the development of drug delivery systems for antiparasitic drugs. Parasitology Research 90 (Suppl. 2), S63S70.

J. Keiser , D. Engels , G. Büscher and J. Utzinger (2005). Triclabendazole for the treatment of fascioliasis and paragonimiasis. Expert Opinion on Investigational Drugs 14, 15131526.

J. Keiser and J. Utzinger (2007). Advances in the discovery and development of trematocidal drugs. Expert Opinion on Drug Discovery 2 (Suppl. 1), S9S23.

J. Keiser and J. Utzinger (2008). Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. JAMA 299, 19371948.

J. Keiser and J. Utzinger (2010). The drugs we have and the drugs we need against major helminth infections. Advances in Parasitology 73, 197230.

I. Kuepfer and C. Burri (2009). Reflections on clinical research in sub-Saharan Africa. International Journal for Parasitology 39, 947954.

C. Lippert , S. Gbenado , C. Qiu , B. Lavin and S. J. Kovacs (2005). The bioequivalence of telithromycin administered orally as crushed tablets versus tablets swallowed whole. Journal of Clinical Pharmacology 45, 10251031.

S. Macleod (2010). Therapeutic drug monitoring in paediatrics: how do children differ? Therapeutic Drug Monitoring 32, 253256.

C. F. Mafiana , U. F. Ekpo and D. A. Ojo (2003). Urinary schistosomiasis in preschool children in settlements around Oyan Reservoir in Ogun State, Nigeria: implications for control. Tropical Medicine and International Health 8, 7882.

G. W. Mellin and M. Katzenstein (1962). The saga of thalidomide. Neuropathy to embryopathy, with case reports of congenital anomalies. New England Journal of Medicine 267, 12381244.

J. A. Mennella and G. K. Beauchamp (2008). Optimizing oral medications for children. Clinical Therapy 30, 21202132.

T. Meyer , H. Sekljic , S. Fuchs , H. Bothe , D. Schollmeyer and C. Miculka (2009). Taste, a new incentive to switch to (R)-praziquantel in schistosomiasis treatment. PLoS Neglected Tropical Diseases 3, e357.

T. M. Michele , B. Knorr , E. B. Vadas and T. F. Reiss (2002). Safety of chewable tablets for children. Journal of Asthma 39, 391403.

C. P. Milne and J. B. Bruss (2008). The economics of paediatric formulation development for off-patent drugs. Clinical Therapy 30, 21332145.

A. Montresor , S. Awasthi and D. W. T. Crompton (2003). Use of benzimidazoles in children younger than 24 months for the treatment of soil-transmitted helminthiasis. Acta Tropica 86, 223232.

M. Moran (2005). A breakthrough in R&D for neglected diseases: new ways to get the drugs we need. PLoS Medicine 2, e302.

M. Moran , J. Guzman , A. L. Ropars , A. McDonald , N. Jameson , B. Omune , S. Ryan and L. Wu (2009). Neglected disease research and development: how much are we really spending? PLoS Medicine 6, e30.

K. N. B. Nor Aripin , I. Choonara and H. M. Sammons (2010 b). A systematic review of paediatric randomised controlled drug trials published in 2007. Archives of Disease in Childhood 95, 469473.

K. N. B. Nor Aripin , H. M. Sammons and I. Choonara (2010 a). Published paediatric randomized drug trials in developing countries, 1996–2002. Paediatric Drugs 12, 99103.

S. Nwaka , and A. Hudson (2006). Innovative lead discovery strategies for tropical diseases. Nature Reviews Drug Discovery 5, 941955.

S. E. Odogwu , N. K. Ramamurthy , N. B. Kabatereine , F. Kazibwe , E. Tukahebwa , J. P. Webster , A. Fenwick and J. R. Stothard (2006). Schistosoma mansoni in infants (aged <3 years) along the Ugandan shoreline of Lake Victoria. Annals of Tropical Medicine and Parasitology 100, 315326.

C. Pandolfini and M. Bonati (2005). A literature review on off-label drug use in children. European Journal of Pediatrics 164, 552558.

G. Pifferi and P. Restani (2003). The safety of pharmaceutical excipients. Farmaco 58, 541550.

H. M. Sammons and I. Choonara (2005). Clinical trials of medication in children, 1996–2002. European Journal of Clinical Pharmacology 61, 165167.

A. D. Schachter and M. F. Ramoni (2007). Paediatric drug development. Nature Reviews Drug Discovery 6, 429430.

J. C. Sousa-Figueiredo , M. Day , M. Betson , N. B. Kabatereine and J. R. Stothard (2010 a). An inclusive dose pole for treatment of schistosomiasis in infants and preschool children with praziquantel. Transaction of the Royal Society of Tropical Medicine and Hygiene 104, 740742.

J. C. Sousa-Figueiredo , J. Pleasant , M. Day , M. Betson , D. Rollinson , A. Montresor , F. Kazibwe , N. B. Kabatereine and J. R. Stothard (2010 b). Treatment of intestinal schistosomiasis in Ugandan preschool children: best diagnosis, treatment efficacy and side-effects, and an extended praziquantel dosing pole. International Health 2, 103113.

J. F. Standing and C. Tuleu (2005). Paediatric formulations – getting to the heart of the problem. International Journal of Pharmacy 300, 5666.

J. R. Stothard and A. F. Gabrielli (2007). Schistosomiasis in African infants and preschool children: to treat or not to treat? Trends in Parasitology 23, 8386.

J. R. Stothard , J. C. Sousa-Figuereido , M. Betson , M. Adriko , M. Arinaitwe , C. Rowell , F. Besiyge and N. B. Kabatereine (2011). Schistosoma mansoni infections in young children: when are schistosome antigens in urine, eggs in stool and antibodies to eggs first detectable? PLoS Neglected Tropical Diseases 5, e938.

M. Strolin Benedetti , R. Whomsley and E. L. Baltes (2005). Differences in absorption, distribution, metabolism and excretion of xenobiotics between the paediatric and adult populations. Expert Opinion on Drug Metabolism and Toxicology 1, 447471.

M. J. Taylor , A. Hoerauf and M. Bockarie (2010). Lymphatic filariasis and onchocerciasis. Lancet 376, 11751185.

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