Sweet Flavours Offer Hope for Children With Drug-Resistant TB

Rallying call to end TB by 2030.

Every day, Yondela Kolweni has to hold down her son, who screams and fights when it’s time for his daily life-saving TB tablets—a painful reminder of her own battle with the world’s top infectious killer.

“It’s a fight I win, but I feel awful about what I have to do,” says Kolweni, 30, a Cape Town resident and TB survivor. “The tablets are bitter, and he spits them out most of the time, which reminds me of when I had to take the same pills.”

Kolweni’s five-year-old son is battling multidrug-resistant TB (MDR-TB), a severe form of TB that is rising among children globally.

According to a recent study, the global burden of MDR-TB among children and adolescents has increased from 1990 to 2019, particularly in regions with lower social and economic development. In 2019, the highest incidence rates of MDR-TB were recorded in Southern Sub-Saharan Africa, Eastern Europe, and South Asia, while the highest death rates were seen in Southern, Central, and Eastern Sub-Saharan Africa.

South Africa is one of 30 countries accounting for 80 percent of all TB cases globally and has the highest number of drug-resistant TB cases.

Kolweni’s son was diagnosed with MDR-TB five years ago, after testing positive for TB, which had already affected his grandmother and mother. He was immediately put on treatment, including moxifloxacin—a drug notorious for its bitterness.

“There were two medications he had to take, but there was one specifically—the yellow one—that he didn’t like. Just seeing the colour, he knew what it was,” Kolweni said, explaining the daily struggle to get her son to take his medicine.

She crushed the tablets, mixed them with water, and fed them to him using a syringe. “We would sometimes hold him or wrap a towel around him so we could give him the medication, but he would still spit it out, which meant he wasn’t getting the proper dose,” said Kolweni.

Attempts to hide the medicine in yoghurt also failed, as her son, being smart, would spit out the mixture once he tasted the bitterness.

Moxifloxacin, one of the key drugs in the new all-oral treatment for MDR-TB, is extremely bitter. The regimen, combining Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin (known as BPaLM), is designed for children but remains difficult to administer.

There is now hope. A study by Stellenbosch University and the TB Alliance found that sweet, bitter-masked versions of moxifloxacin significantly improve children’s willingness to take the drug—easing the burden on parents and improving treatment adherence.

The ChilPref ML study, funded by Unitaid, showed that children strongly preferred new flavour blends—such as orange, strawberry, raspberry, and tutti frutti—over existing formulations.

Dr Graeme Hoddinott, the study’s lead investigator, noted that treating children humanely requires making medicines palatable. “It’s a trauma to administer such bad-tasting drugs to a child, both for the parent and the child, particularly young children,” he said.

The study involved nearly 100 children aged 5–17 in South Africa, who evaluated the taste of the formulations using a ‘swish and spit’ method. Feedback from the children has already led manufacturers to update their products.

Dr Cherise Scott of Unitaid said, “The easier it is for children to take their medicines regularly, the more likely they are to complete treatment successfully.”

As MDR-TB cases rise among children, Dr Anthony Garcia-Prats of the University of Wisconsin-Madison highlighted the importance of developing new, child-friendly treatments. “Now we’re making sure that these medicines are appropriate for children, starting with taste,” he said.

Annually, an estimated 32,000 children aged 14 and under develop RR/MDR-TB, a group particularly sensitive to bitter tastes.

While not a complete solution, the development of flavoured medicines marks an important step in improving adherence and working towards the UN’s goal of ending TB by 2030.

Kolweni welcomed the development. “My experience with TB medication was terrible. Flavoured tablets or even a suspension would make it easier for children. My son would love it—and I wouldn’t have to fight him anymore.”