New WHO guidance to improve use of medicines for children

Model Formulary for Children provides information on how to use over 240 essential medicines

GENEVA -- The first ever WHO Model Formulary for Children released by the WHO provides information on how to use over 240 essential medicines for treating illness and disease in children from 0 to 12 years of age. This means that for the first time medical practitioners worldwide have access to standardized information on the recommended use, dosage, adverse effects, and contraindications of these medicines for use in children. A number of individual countries have developed their own formularies over the years, but until now there was no single comprehensive guide to using medicines in children for all countries.

“To be effective, medicines must be carefully chosen and the dose adjusted to suit the age, weight and needs of children,” said Dr Hans Hogerzeil, Director of Essential Medicines and Pharmaceutical Policies at WHO. “Without a global guide, many health-care professionals have had to prescribe medicines based on very limited evidence.”
Based on global evidence

The new Formulary is based on the best global evidence available as to which medicines should be used to treat specific conditions, how they should be administered and in what dose. Accurate dosing of medicines for use in children is essential, particularly those between 0-12 months. A dosing error in a child this small can have devastating results.
How the Formulary will help

The Formulary will help health-care providers prescribe the right medicine, in the right formulation and the right dose. It also highlights what precautions to take, what adverse reactions may need to be monitored, and what kind of interactions may occur if the patient is taking other medications. For example, the Formulary indicates that ibuprofen, which is frequently given to children to treat pain, can have negative interactions when taken with any one of twenty-one listed medicines. It is also important to give this medicine with or after food.

In the case of medicines to treat malaria or HIV, the Formulary highlights the need for better fixed dose combinations - several medicines in one pill - for effective and safe treatment in children. Currently very few fixed dose combinations exist for children; just one anti-malarial and two antiretrovirals to treat children with HIV.

In developing the Formulary a number of areas were identified where more research is needed to provide better treatment for children, such as child appropriate antibiotics to treat pneumonia and specific medicines for neonatal care.
Importance of the Formulary

Each year 8.8 million children under five die (2008 data). Many of these deaths are caused by diseases which could be avoided with the use of safe essential medicines formulated appropriately for children. These include diarrhoea and pneumonia as well as conditions such as severe bacterial infections in newborns.
Background information

In 2007, WHO celebrated the 30th anniversary of the WHO Model List of Essential Medicines. In reviewing the progress made over the years, it was noted that there was a need for more medicines specifically developed and tested for use in children. In December 2007, WHO launched the “Make medicines child size” campaign to raise awareness of the issue among policy-makers, pharmaceutical manufacturers, researchers, health-care professionals and the public. The release of the first-ever WHO Model List of Essential Medicines for Children identified medicines that should be available for use in children. The development of the WHO Model Formulary for Children builds on the WHO Model List of Essential Medicines for Children by providing prescribing guidance and is part of a series of activities WHO has undertaken as part of the “Make medicines child size” campaign and the Better Medicines for Children initiative. WHO will support countries to develop their national formularies for children.