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Patil PS, Suryawanshi SJ, Patil SS, Pawar AP. HME-assisted formulation of taste-masked dispersible tablets of cefpodoxime proxetil and roxithromycin. J Taibah Univ Med Sci 2024; 19:252-262. [PMID: 38616800 PMCID: PMC11010712 DOI: 10.1016/j.jtumed.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/10/2023] [Accepted: 12/13/2023] [Indexed: 04/16/2024] Open
Abstract
Objectives Antibiotics are the most commonly administered medications among pediatric patients. However most of the time, accurate dose administration to children becomes a problem due to the extremely bitter taste. Cefpodoxime proxetil (CP) and roxithromycin (ROX) are antibiotics often prescribed to the pediatric population and have a bitter taste. Marketed formulations of these drugs are dry suspension and/or tablets. The lyophilization method involves various steps and thus is time consuming and expensive. The objective of this study was to mask the bitter taste of CP and ROX without compromising the solubility and drug release profile compared to marketed formulations, as well as to overcome the disadvantages associated with the currently used lyophilization technique. Methods Hot melt extrusion (HME) technology was used to process CP and ROX individually with Eudragit E PO polymer. The extrudates obtained were characterized by Fourier transform infrared spectroscopy, powder X-ray diffraction, and differential scanning calorimetry. The powdered extrudates were formulated as dispersible tablets and evaluated for in vitro and in vivo taste-masking efficiency. Results The tablets prepared in this study showed comparable dissolution profiles but the taste-masking efficiency was significantly enhanced compared to the marketed tablets of CP and ROX. The results of in vivo human taste-masking evaluation were also in agreement with the in vitro taste-masking studies. Conclusion The current work presents solvent-free, scalable, and continuous HME technology for addressing the bitter taste issues of CP and ROX. The disadvantages associated with the currently used lyophilization technique were overcome by developing the formulations using HME technology.
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Affiliation(s)
- Prathamesh S. Patil
- Department of Pharmaceutics, Bharati Vidyapeeth (Deemed to be University), Poona College of Pharmacy, Pune, Maharashtra, India
- STEERLife India Pvt. Ltd, Bengaluru, Karnataka, India
| | | | - Sharvil S. Patil
- Department of Pharmaceutics, Bharati Vidyapeeth (Deemed to be University), Poona College of Pharmacy, Pune, Maharashtra, India
| | - Atmaram P. Pawar
- Department of Pharmaceutics, Bharati Vidyapeeth (Deemed to be University), Poona College of Pharmacy, Pune, Maharashtra, India
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Viprakasit V, Hamdy MM, Hassab HMA, Sherief LM, Al-Bagshi M, Khattab M, Chuncharunee S, Dung PC, Küpesiz A, Shekhawat A, Sonawane Y, Perez LT, Slader C, Taher AT. Patient preference for deferasirox film-coated versus dispersible tablet formulation: a sequential-design phase 2 study in patients with thalassemia. Ann Hematol 2023:10.1007/s00277-023-05240-3. [PMID: 37227493 DOI: 10.1007/s00277-023-05240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/17/2023] [Indexed: 05/26/2023]
Abstract
Iron chelation therapy (ICT) is the mainstay of treatment in patients with thalassemia requiring blood transfusions. This phase 2 JUPITER study evaluated patient preference between film-coated tablet (FCT) and dispersible tablet (DT) in transfusion-dependent thalassemia (TDT) or non-TDT (NTDT) patients treated with both formulations in a sequential manner. The primary endpoint was patient-reported preference for FCT over DT, while secondary outcomes included patient reported outcomes (PROs) evaluated by overall preference, and by age, thalassemia transfusion status, and previous ICT status. Out of 183 patients screened, 140 and 136 patients completed the treatment periods 1 and 2 of the core study, respectively. At week 48, the majority of patients preferred FCT over DT (90.3 vs. 7.5%; difference of percentage: 0.83 [95% confidence interval (CI), 0.75-0.89; P < 0.0001]). FCT scored better on secondary PROs and showed less severe gastrointestinal symptoms than DT, except in the change of modified Satisfaction with Iron Chelation Therapy (mSICT) preference scores, which were similar for both the formulations. Patients with TDT had stable ferritin levels, while it showed a downward trend up to week 48 in patients with NTDT on deferasirox treatment. Overall, 89.9% of patients reported ≥ 1 adverse event (AE), of which 20.3% experienced ≥ 1 serious AE. The most common treatment-emergent AEs were proteinuria, pyrexia, urine protein/creatinine ratio increase, diarrhea, upper respiratory tract infections, transaminase increase, and pharyngitis. Overall, this study reinforced the observations from the previous study by showing a distinct patient preference for FCT over DT formulation and further supported the potential benefits of life-long compliance with ICT.
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Affiliation(s)
- Vip Viprakasit
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, 10700, Thailand
| | - Mona M Hamdy
- Clinical Research Center, Cairo University, Cairo, 11562, NA, Egypt
| | - Hoda M A Hassab
- Pediatric Department & Clinical Research Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Laila M Sherief
- Faculty of Medicine, Zagazig University, Zagazig Sharqia, 44519, Egypt
| | | | - Mohammed Khattab
- Centre d'Hématologie Et d'oncologie Pédiatrique - CHU Ibn Sina Rabat, 10102, Rabat, Morocco
| | | | - Phu Chi Dung
- Hochiminh City Blood Transfusion Hematology Hospital, Ho Chi Minh City, 700000, Vietnam
| | | | | | - Yamini Sonawane
- Novartis Healthcare Private Limited, Hyderabad, India, 500081
| | | | | | - Ali T Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Anand L, Pentapati K, Shenoy R, Yelleti G, Kumar S. Sugar content and erosive potential of commonly prescribed Oro dispersible tablets- An in vitro study. F1000Res 2023; 12:228. [PMID: 37089132 PMCID: PMC10114003 DOI: 10.12688/f1000research.130786.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
Background: Dental caries is a major non-communicable disease of public health concern caused due to freely available dietary sugars. We aimed to compare the sugar content and erosive potential with duration of use and drug classes of orodispersible tablets (ODTs). Methods: We conducted an in vitro evaluation of the total sugar content (TSC), Potential of Hydrogen (pH), solubility, and Titratable Acidity (TA) of commonly prescribed 62 ODTs. TA was measured by titrating the samples with known amount of. 0.1N sodium hydroxide (NaOH) with phenolphthalein indicator and pH was determined by digital pH meter. TSC was evaluated by phenol sulphuric acid. Solubility was assessed by filtration. Results: Out of the 62 ODTs, majority were Antimicrobials (n=30). One-quarter of the ODTs (26%) had a mean pH below ≤5.5. No significant difference was seen in the mean pH with respect to different drug classes (p=0.082) and duration of use of ODTs. A significant difference was seen in the mean percentage solubility with respect to drug classes (p<0.001). Antimicrobials had the least percentage of solubility as compared to other drug classes. Antiemetics and proton pump inhibitors (24.33 ± 17.34) had significantly higher mean percentage sugar content than Antimicrobials (23.25 ± 17.16). No significant difference was seen in the mean TSC with respect to various drug classes (p=0.718) and between the duration of use of drugs (P=0.568) respectively. No significant difference was seen in the mean percentage TA with respect to drug class (p=0.123) and duration of use of drugs (p=0.424). Conclusion: Overall, we can conclude that one in four ODT formulations had a pH below 5.5 (critical pH). Only one ODT formulation did not have a sugar content. No difference was seen in the mean pH, sugar content, and TA with respect to duration of use of drugs and drug classes.
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Affiliation(s)
- Lahari Anand
- Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kalyana Pentapati
- Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Revathi Shenoy
- Biochemistry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Geethika Yelleti
- Biochemistry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Saurabh Kumar
- Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Ginsburg AS, May S. Adherence to oral amoxicillin dispersible tablets in children with community-acquired pneumonia enrolled in clinical trials in Malawi. Pneumonia (Nathan) 2021; 13:10. [PMID: 34167590 PMCID: PMC8228938 DOI: 10.1186/s41479-021-00089-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Amy Sarah Ginsburg
- University of Washington, Seattle, WA, USA. .,University of Washington Clinical Trial Center, Building 29, Suite 250, 6200 NE 74th Street, Seattle, WA, 98115, USA.
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Angwa LM, Ouma C, Okoth P, Nyamai R, Kamau NG, Mutai K, Onono MA. Acceptability, adherence, and clinical outcomes, of amoxicillin dispersible tablets versus oral suspension in treatment of children aged 2-59 Months with pneumonia, Kenya: A cluster randomized controlled trial. Heliyon 2020; 6:e03786. [PMID: 32322742 PMCID: PMC7160563 DOI: 10.1016/j.heliyon.2020.e03786] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 01/13/2023] Open
Abstract
Amoxicillin dispersible tablet (DT) is now recommended by the WHO as a first-line drug for the treatment of pneumonia in children below 5 years. The study aim was to compare acceptability, adherence and clinical outcome of amoxicillin DT and amoxicillin oral suspension (OS) in the treatment of children aged 2–59 months with pneumonia in Kenya. We conducted a two-arm cluster randomized controlled trial and utilized quantitative methods. The community unit was the unit of randomization. Children aged 2–59 months with pneumonia were enrolled and treated with either amoxicillin DT or OS. Acceptability was defined as the perception of taste of medication as the same or better compared to other medicines and expression of willingness of caregivers to use DT/OS in future, adherence was measured based on the dose, frequency, and duration of treatment, and clinical outcome as complete resolution of symptoms without change of antibiotic treatment. Equivalence was defined as a difference of ≤8% between study arms. We found high levels of acceptability among both DT (93.9%) and OS (96.1%) arms (difference 2.3%, 90% CI -2.6-7.3). The objective measure of adherence on day four and the overall objective measure were significantly higher among children on DT compared to children on OS (88.7% vs. 41.5% (difference 47.2%, 90% CI 31.0–63.3) & 83.5% vs. 39% (difference 44.5%, 90% CI 27.9–60.9), respectively). Cure rates were high in both arms (DT (99.5%), OS (98.1%), difference 1.4%, 90% CI -0.2-3.2). There is reported better adherence to Amoxicillin DT compared to OS and equivalence in acceptability and clinical outcomes.
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Affiliation(s)
- Linet M Angwa
- Department of Clinical Medicine, Kabarak University, Kenya
| | - Collins Ouma
- Department of Biomedical Sciences and Technology, Maseno University, Kenya
| | | | | | - Nyawira G Kamau
- Institute of Tropical Medicine, Jomo Kenyatta University, Kenya
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Rahman M, Delarosa J, Luies SK, Alom KR, Quintanar-Solares M, Jabeen I, Ahmed T, Abu-Haydar E, Sarma H. Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative study. BMC Health Serv Res 2020; 20:142. [PMID: 32093696 PMCID: PMC7041088 DOI: 10.1186/s12913-020-4982-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 02/12/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Pneumonia and possible serious bacterial infection (PSBI) are leading causes of death among under-five children. The World Health Organization (WHO) issued global recommendations for the case management of childhood pneumonia and PSBI when referral is not feasible with oral amoxicillin. However, few governments to date have incorporated child-friendly amoxicillin dispersible tablets (DT) into their national treatment guidelines and policies. We aimed to understand the key drivers to the implementation of WHO recommendations for childhood pneumonia and PSBI using amoxicillin DT in Bangladesh. METHODS A qualitative study was conducted from October 2017 to March 2018 in two districts of Bangladesh. Interviews were completed with 67 participants consisting of government officials and key stakeholders, international development agencies, health service providers (HSPs), and caregivers of young children diagnosed and treated with amoxicillin for pneumonia or PSBI. Data were analyzed thematically. RESULTS Policies and operational planning emerged as paramount to ensuring access to essential medicines for childhood pneumonia and PSBI. Though amoxicillin DT is included for National Newborn Health Programme and Integrated Management of Childhood Illnesses in the Operational Plan of the Directorate General of Health Services, inclusion in Community-Based Healthcare Project and Directorate General of Family Planning policies is imperative to securing national supply, access, and uptake. At the sub-national level, training on the use of amoxicillin DT as a first line intervention is lacking, resulting in inadequate management of childhood pneumonia by HSPs. Advocacy activities are needed to create community-wide demand among key stakeholders, HSPs, and caregivers not yet convinced that amoxicillin DT is the preferred formulation for the management of childhood pneumonia and PSBI. CONCLUSION Challenges in policy and supply at the national level and HSP preparedness at the sub-national levels contribute to the slow adoption of WHO recommendations for amoxicillin DT in Bangladesh. A consultation meeting to disseminate study findings was instrumental in driving the development of recommendations by key stakeholders to address these challenges. A comprehensive and inclusive evidence-based strategy involving all divisions of the Ministry of Health and Family Welfare will be required to achieve national adoption of WHO recommendations and country-wide introduction of amoxicillin DT in Bangladesh.
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Affiliation(s)
- Mahfuzur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) 68, Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212 Bangladesh
| | - Jaclyn Delarosa
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121 USA
| | - Sharmin Khan Luies
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) 68, Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212 Bangladesh
| | - Kazi Robiul Alom
- Department of Anthropology, University of Rajshahi, Rajshahi, Bangladesh
| | | | - Ishrat Jabeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) 68, Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212 Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) 68, Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212 Bangladesh
| | | | - Haribondhu Sarma
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) 68, Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212 Bangladesh
- Research School of Population Health, the Australian National University, Acton, ACT 2601 Australia
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