Optimising Paediatric Medication Adherence Through Innovative Drug Formulations and Delivery Systems

Abstract

Medication adherence remains a significant challenge in healthcare, particularly in paediatric populations, where non-adherence has a substantial impact on therapeutic outcomes and contributes to increased healthcare costs. This manuscript emphasises the central role of drug formulations and delivery systems in shaping adherence behaviours in children. Given the unique pharmacokinetic characteristics of paediatric patients, formulation design has a critical impact on medication efficacy, safety and acceptability. By integrating pharmacological considerations with innovative formulation strategies and tailored care approaches, this work provides practical and evidence-informed pathways to enhance medication adherence and improve clinical outcomes in paediatric care.

Introduction

Medication adherence, defined as the extent to which patients follow prescribed medication regimens, is a critical determinant of therapeutic success [1]. Despite its importance, adherence to long-term therapies remains suboptimal worldwide. In paediatric populations, adherence is often lower and more variable than in adults, reflecting a complex interplay of developmental, pharmacological and behavioural factors (refer to Table 1). Unlike adults, children depend largely on caregivers for medication administration, and adherence is influenced by formulation-related characteristics such as taste, acceptability, swallowing ability, dosing frequency and the child’s age and stage of maturation (see Fig. 1) [2,3,4].

Non-adherence has substantial clinical and healthcare system consequences, including suboptimal therapeutic outcomes, an increased risk of disease progression and higher healthcare utilisation [2, 3]. Reported estimates of paediatric medication adherence vary widely, ranging from 13 to approximately 90%, depending on the disease, age group and treatment regimen [4]. This considerable variability emphasises the need for targeted, child-specific adherence strategies.

Treatment adherence in paediatric care has been less extensively studied than in adult populations; however, the determinants of adherence appear to be more complex [5, 6]. Responsibility for adherence typically lies with caregivers rather than the patients themselves. Moreover, paediatric care is characterised by a distinct ‘therapeutic triad’, involving dynamic interactions among caregivers, healthcare professionals and children, as well as between caregivers and children [5, 7]. These relational and contextual factors further complicate adherence behaviours in children.

Given these challenges, effective strategies to improve paediatric medication adherence must prioritise factors that directly influence children’s ability and willingness to take medicines [1, 8]. Drug formulations and delivery systems play a central role in this regard. Age-appropriate dosage forms such as liquids, dispersible tablets, chewable formulations and extended-release preparations are essential not only for pharmacokinetic appropriateness but also for enhancing acceptability, ease of administration and overall adherence.

Evidence indicates that medication adherence interventions are most effective when they are multifaceted, combining simplified care pathways, patient and caregiver education, reminder systems, behavioural strategies and active involvement in treatment decision-making [5]. In paediatric populations, multicomponent interventions similarly demonstrate the greatest benefit; however, reported effect sizes remain modest and variable, highlighting the need for further high-quality research to optimise adherence outcomes in children.

Patient-related factors, including sociodemographic characteristics, psychosocial factors, comorbid conditions, cognitive function and health beliefs, influence adherence (see Table 1). While socio-demographic traits such as age, gender and race, as well as comorbidities, are largely non-modifiable, other factors present opportunities for intervention. Adherence in paediatric populations presents unique challenges, as children often rely on caregivers for medication administration [2,3,4]. Factors such as palatability, dosing frequency, formulation type and the child’s developmental stage further complicate adherence. Non-adherence in children leads to suboptimal therapeutic outcomes, increased disease progression and higher healthcare costs [2].

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Ngcobo, N.N. Optimising Paediatric Medication Adherence Through Innovative Drug Formulations and Delivery Systems. Clin Pharmacokinet (2026). https://doi.org/10.1007/s40262-026-01630-8