Child-Friendly TB Drug Flavours Identified

Two new formulations of moxifloxacin—an antibiotic critical in the treatment of drug-resistant tuberculosis (TB)—have been identified as significantly more palatable by children than current generic versions on the market. The findings come from the ChilPref ML study, funded by Unitaid and led by Stellenbosch University in partnership with TB Alliance.

The study found that children clearly preferred two newly developed flavour blends of moxifloxacin from Indian pharmaceutical manufacturers Macleods and Micro Labs. These new formulations, which include flavours like "bitter masker & orange" and "strawberry & raspberry," were rated far more favourably in terms of taste, smell, and overall acceptability.

“This represents a major step forward,” said Dr. Anthony J. Garcia-Prats, an associate professor at the University of Wisconsin-Madison and one of the study’s authors. “We’ve made significant strides in developing effective treatments for drug-resistant TB. Now we’re ensuring that these medicines are actually usable by children—starting with taste.”

Moxifloxacin, known for its extremely bitter taste, is one of four key drugs used in the new all-oral BPaLM regimen for treating rifampicin-resistant and multidrug-resistant TB (RR/MDR-TB). While young children are not yet recommended for the full BPaLM regimen, they frequently receive moxifloxacin as part of other TB treatments.

The ChilPref ML study enlisted nearly 100 healthy children aged 5 to 17 in South Africa. Using a ‘swish and spit’ method—tasting but not swallowing the medicine—participants rated three flavour blends of moxifloxacin and linezolid (another key TB drug) from each manufacturer. While no significant preference emerged for the linezolid flavours, the moxifloxacin results were clear: children consistently favoured the newly developed blends over existing versions.

“Trying to get a child to take bitter medication every day for six to nine months is an immense challenge,” said Dr. Graeme Hoddinott, the study’s principal investigator at Stellenbosch University. “If the medicine is too unpleasant, adherence drops, which undermines treatment success.”

Globally, an estimated 25,000 to 32,000 children under 15 develop RR/MDR-TB each year. Moreover, moxifloxacin may soon play a larger role in treating drug-susceptible TB, which affects around 1.2 million children annually. That makes the development of child-friendly formulations all the more urgent.

“This initiative has demonstrated that it’s not only possible—but essential—to involve children in determining the acceptability of the medicines they’re given,” said Koteswara Rao Inabathina, CMC Project Manager at TB Alliance. “By addressing palatability, we’re improving both access and outcomes.”

Cherise Scott, Senior Technical Manager at Unitaid, underscored the broader significance: “Children must not be sidelined in global health just because their needs are more complex. Making medicine easier for children to take is key to ensuring they complete their treatment.”

The study’s approach—cost-effective, safe, and scalable—offers a template for improving the acceptability of TB drugs and other essential medicines for children worldwide, says a press release.