A critical comparison between the World Health Organization list of essential medicines for children and the Brazilian list of essential medicines (Rename)

Coelho, Helena Lutéscia L.; Rey, Luís Carlos; de Medeiros, Marina S.G.; Barbosa, Ronaldo A.; da Cruz Fonseca, Said G.; da Costa, Patricia Q.

doi:10.1016/j.jped.2013.03.004

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Abstract

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Abstract

Objective

To perform a critical comparison between the Brazilian national essential medicines list (Rename, 2012) with the list of essential medicines for children (LEMC, 2011) of the World Health Organization (WHO), regarding the differences among drugs and formulations listed for children.

Methods

The LEMC drugs were classified into four categories: 1) absent in Rename; 2) included in Rename but without any formulation suitable for children; 3) listed in Rename only in some formulations; 4) present in Rename in all formulations. The missing formulations were analyzed by therapeutic group. Alternatives present in Rename were searched.

Results

From the 261 drugs of interest on the LEMC, 30.3% are absent from Rename, 11.1% are in Rename but without any pediatric formulation, and 32.2% are present in some but not all formulations listed in LEMC. Considering all formulations items listed in the LEMC (n = 577), 349 are missing from Rename, of these 19.6% due to their strength, and 18.5% due to the the dosage form. Useful formulations specific for neonatal care, respiratory tract, central nervous system, and anti-infectives, among other groups, are missing.

Conclusion

The lack of age-appropriate formulations of essential medicines for children in Brazil includes important therapeutic groups and indispensable drugs for severe clinical conditions. Some of these products exist in the Brazilian pharmaceutical market, but not in public facilities; others could be produced by national laboratories with commercial interest or stimulated by a specific governmental policy, as in other countries.

Keywords:

Newborn

Infant

Child

Pharmaceutical preparations

Health public policy

Drugs

essential

Resumo

Objetivo

Realizar uma comparação crítica entre a Relação Nacional de Medicamentos Essenciais (Rename, 2012) e a Lista de Medicamentos Essenciais para Crianças (LMEC, 2011) da Organização Mundial de Saúde (OMS), com relação às diferenças entre os medi- camentos e as formulações listadas para crianças.

Métodos

Os medicamentos da LMEC foram classificados em quatro grupos: 1) não cons- tam na Rename; 2) constam na Rename, porém sem qualquer formulação adequada para crianças; 3) listados na Rename apenas com algumas formulações; 4) constam na Rename em todas as formulações. As formulações que faltam foram analisadas por grupos tera- pêuticos. As alternativas presentes na Rename foram pesquisadas.

Resultados

Dos 261 medicamentos de interesse listados na LMEC, 30,3% não estão pre- sentes na Rename, 11,1% estão na Rename, mas sem qualquer formulação pediátrica, e 32,3% estão presentes em algumas, mas não todas as formulações listadas na LMEC. Considerando todos os itens de formulações listados na LMEC (n = 577), 349 não constam na Rename, desses, 19,6% devido à intensidade de dosagem, e 18,5% devido à forma farmacêutica. Faltam formulações úteis específicas para cuidado neonatal, trato respi- ratório e sistema nervoso central, anti-infecciosos, entre outros grupos.

Conclusão

A ausência de formulações adequadas à idade de medicamentos essenciais para crianças no Brasil inclui importantes grupos terapêuticos e medicamentos indispen- sáveis para quadros clínicos graves. Alguns desses produtos são encontrados no mercado farmacêutico brasileiro, porém não existem em unidades públicas; outros poderiam ser produzidos por laboratórios nacionais com interesse comercial ou estimulados por uma política governamental específica, como é feito em outros países.

Palavras-chave:

Recém-nascido

Neonato

Criança

Preparações farmacêuticas

Política de saúde pública

Medicamentos essenciais

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*

Please, cite this article as: Coelho HL, Rey LC, de Medeiros MS, Barbosa RA, Fonseca SG, da Costa PQ. A critical comparison between the World Health Organization list of essential medicines for children and the Brazilian list of essential medicines (Rename). J Pediatr (Rio J). 2013;89:171−8.

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