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Mwalwisi YH, Fimbo AM, Hoellein L, Nandonde M, Sambu G, Ahmed B, Juma A, Augustine S, Shewiyo DH, Kaale EA, Holzgrabe U. The comparison of the quality of selected brands of antibiotics in Tanzania sourced from different geographical regions. J Antimicrob Chemother 2024:dkae155. [PMID: 38804149 DOI: 10.1093/jac/dkae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES The quality of amoxicillin capsules, ceftriaxone for injection, and ciprofloxacin tablets was evaluated to determine whether there is any difference in quality when comparing the country of origin. This was undertaken because it has been claimed that antibiotics manufactured in Europe are of superior quality to those originating from Africa or Asia. METHODS Samples of amoxicillin capsules, ceftriaxone for injection, and ciprofloxacin tablets were collected from three randomly selected wholesale pharmacies in each city, namely Arusha, Dar es Salaam and Mwanza, Tanzania. The collected samples of collected brands were subjected to quality control testing as per their respective pharmacopoeial monographs. Amoxil 250 mg capsules (Glaxo Wellcome, Mayenne, France), Rocephin (Roche, Switzerland) and Cipro-Denk 500 (Allphamed Pharbil Arzneimittel GmbH, Gottingen, Germany) were used as reference brands for the other generic brands of amoxicillin, ceftriaxone and ciprofloxacin, respectively. RESULTS A total of 31 brands (10 different brands of amoxicillin capsules, 9 of ceftriaxone sodium injections, and 12 of ciprofloxacin tablets) were collected from the targeted regions and subjected to quality control testing. All samples of collected brands complied with the requirements of their respective pharmacopoeial monographs. CONCLUSIONS There was no significant difference in quality between brands of amoxicillin capsules, ceftriaxone for injection, and ciprofloxacin tablets manufactured in Africa and Asia against those manufactured in Europe in terms of compliance with the respective pharmacopoeial monographs.
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Affiliation(s)
- Yonah Hebron Mwalwisi
- Human and Veterinary Medicines, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
| | - Adam Mitangu Fimbo
- Human and Veterinary Medicines, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
| | - Ludwig Hoellein
- Pharmaceutical and Medicinal Chemistry, Institute for Pharmacy and Food Chemistry, Universität Würzburg, 97074 Würzburg, Germany
| | - Moses Nandonde
- Human and Veterinary Medicines, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
- Laboratory Services, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
| | - Gerald Sambu
- Human and Veterinary Medicines, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
- Laboratory Services, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
| | - Babuali Ahmed
- Human and Veterinary Medicines, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
- Laboratory Services, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
| | - Abdalla Juma
- Human and Veterinary Medicines, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
- Laboratory Services, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
| | - Siya Augustine
- Human and Veterinary Medicines, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
- Laboratory Services, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
| | - Danstan Hipolite Shewiyo
- Human and Veterinary Medicines, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
- Laboratory Services, Tanzania Medicines and Medical Devices Authority (TMDA), Dar es Salaam, Tanzania
| | - Eliangiringa Amos Kaale
- Pharm R&D Lab, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65545, 11103, Upanga West, Dar es Salaam, Tanzania
| | - Ulrike Holzgrabe
- Pharmaceutical and Medicinal Chemistry, Institute for Pharmacy and Food Chemistry, Universität Würzburg, 97074 Würzburg, Germany
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Tabernero P, Swamidoss I, Mayxay M, Khanthavong M, Phonlavong C, Vilayhong C, Sichanh C, Sengaloundeth S, Green MD, Newton PN. A random survey of the prevalence of falsified and substandard antibiotics in the Lao PDR. J Antimicrob Chemother 2022; 77:1770-1778. [PMID: 35137095 PMCID: PMC7614350 DOI: 10.1093/jac/dkab435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In 2012, a stratified random survey, using mystery shoppers, was conducted to investigate the availability and quality of antibiotics sold to patients in the private sector in five southern provinces of the Lao People's Democratic Republic (Laos). METHODS A total of 147 outlets were sampled in 10 districts. The active pharmaceutical ingredient (API) content measurements for 909 samples, including nine APIs (amoxicillin, ampicillin, ceftriaxone, ciprofloxacin, doxycycline, ofloxacin, sulfamethoxazole, tetracycline and trimethoprim), were determined using HPLC. RESULTS All the analysed samples contained the stated API and we found no evidence for falsification. All except one sample had all the units tested with %API values between 75% and 125% of the content stated on the label. However, we identified the presence of substandard antibiotics: 19.6% (201/1025) of samples had their units outside the 90%-110% content of the label claim and 18.3% (188/1025) of the samples had units outside the International Pharmacopoeia/United States Pharmacopoeia assay (percentage of label claim) specifications. Trimethoprim had a high number of samples [51.6% (64)] with units below the limit range, followed by ceftriaxone [42.9% (3)] and sulfamethoxazole [34.7% (43)]. Doxycycline, ofloxacin and ciprofloxacin had the highest number of samples with high API content: 43.7% (38), 14.7% (10) and 11.8% (2), respectively. Significant differences in %API were found between stated countries of manufacture and stated manufacturers. CONCLUSIONS With the global threat of antimicrobial resistance on patient outcomes, greater understanding of the role of poor-quality antibiotics is needed. Substandard antibiotics will have reduced therapeutic efficacy, impacting public health and control of bacterial infections.
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Affiliation(s)
- Patricia Tabernero
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Public Health Unit, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain
| | - Isabel Swamidoss
- Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuf?eld Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | | | - Chindaphone Phonlavong
- Bureau of Food and Drug Inspection (BFDI), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Chanthala Vilayhong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Chanvilay Sichanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sivong Sengaloundeth
- Food and Drug Department (FDD), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Michael D. Green
- Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, Nuf?eld Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
- Infectious Diseases Data Observatory, Nuf?eld Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Hoellein L, Kaale E, Mwalwisi YH, Schulze MH, Vetye-Maler C, Holzgrabe U. Emerging Antimicrobial Drug Resistance in Africa and Latin America: Search for Reasons. Risk Manag Healthc Policy 2022; 15:827-843. [PMID: 35519501 PMCID: PMC9064051 DOI: 10.2147/rmhp.s205077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Medicine quality and methods for its assessment play a major role in the effectiveness of therapies and the treatment of many infectious diseases. However, poor-quality and/or falsified products are circulating in huge amounts in many low- and middle-income countries and are one of the major reasons why more and more resistant bacteria emerge. The development of resistance is additionally triggered by a plethora of antibiotic medicines which is easily available through pharmacies and unofficial sources. The uncontrolled overuse of these products is a huge problem not only in single countries but worldwide. In this review, we aim to demonstrate the factors which are involved in an emerging resistance development and how strong regulatory authorities, routine quality control by means of proficiency testing, and post-marketing surveillance as well as training personnel and patients can be combined to curb the problem.
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Affiliation(s)
- Ludwig Hoellein
- Institute for Pharmacy and Food Chemistry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Eliangiringa Kaale
- Muhimbili University of Health and Allied Sciences, School of Pharmacy, Dar es Salaam, Tanzania
| | | | - Marco H Schulze
- Georg-August-Universität Göttingen, Institut für Krankenhaushygiene und Infektiologie, Göttingen, Germany
| | | | - Ulrike Holzgrabe
- Institute for Pharmacy and Food Chemistry, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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Investigation of the Quality of the 12 Most-Used Antibiotics Available in Retail Private Pharmacies in Rwanda. Antibiotics (Basel) 2022; 11:antibiotics11030329. [PMID: 35326792 PMCID: PMC8944805 DOI: 10.3390/antibiotics11030329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 02/05/2023] Open
Abstract
Using poor-quality antibiotics leads to increased risk of the development of microorganism-resistant strains, treatment failure, loss of confidence in health systems, and associated socio-economic impacts. The prevalence of poor-quality antibiotics has been found to be high in some of the Low and Middle-Income Countries (LMICs), but no data were available on the situation in Rwanda. This study was conducted to obtain data and inform health professionals on the quality of the 12 most-used selected antibiotics from private retail pharmacies in Rwanda. The investigation was conducted on 232 batches collected from randomly selected private retail pharmacies in all provinces of Rwanda, and concerned only with visual inspection and assay tests. Visual inspection was performed using a tool adopted by the International Pharmaceutical Federation (FIP) to identify manufacturing defects. An assay test quantified the Active Pharmaceutical Ingredient (API) in each collected batch using high-performance liquid chromatography (HPLC) coupled with an ultraviolet-visible (UV) detector, and the results were reported as the percentage content of the amount of APIs stated on the label. A total of 232 batches were analyzed, manufactured in 10 countries; the main country of manufacture was Kenya, with almost half of the batches (49.6%). The results of the visual inspection did not show the presence of counterfeit/ falsified antibiotics on the Rwandan market in this study but revealed weaknesses in labeling: more than 90% of the analyzed batches of the 12 antibiotics did not present the dosage statement on their label, and the complete list of excipients was missing in more than 20% of the analyzed batches. The assay test using HPLC confirmed the presence of APIs in 100% of the analyzed batches. However, moderate deviations from acceptable ranges of the API content defined by M. M. Nasr & C. M. Stanley in 2006 for erythromycin and the United States Pharmacopoeia 2018 for the other 11 molecules were found. The failure rate to meet the quality requirements in terms of the percentage content of active pharmaceutical ingredients declared on the labels was estimated at 8.2% in total, with 3.9% and 4.3% containing more and less than the amount of APIs stated on the labels respectively. The most-represented antibiotics on the Rwandan market were amoxicillin, co-trimoxazole and cloxacillin. No counterfeit antibiotics were found in this study. However, substandard batches with moderate deviations were found, suggesting that regular quality control of antibiotics is needed in Rwanda.
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Irungu BN, Koech LC, Ondicho JM, Keter LK. Quality assessment of selected co-trimoxazole suspension brands marketed in Nairobi County, Kenya. PLoS One 2021; 16:e0257625. [PMID: 34551002 PMCID: PMC8457504 DOI: 10.1371/journal.pone.0257625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Quality of medicines in both developed and developing countries is sometimes compromised due to infiltration of counterfeit, substandard or degraded medicines into the markets. It is a public health concern as poor quality medicines endanger public health where patients are exposed to chemical toxins and/or sub-therapeutic doses. This could lead to reduced treatment efficacy and promote development of drug resistance. Co-trimoxazole, a fixed dose combination of sulfamethoxazole and trimethoprim, is a broad spectrum for bacterial diseases and is also used as a prophylaxis for opportunistic infections in HIV infected individuals. This study evaluated quality of selected co-trimoxazole suspension brands marketed in Nairobi County, Kenya. METHODS A total of 106 samples were collected, categorized into 15 brands and evaluated for active pharmaceutical ingredient content (API) and pH following United States Pharmacopeia. Assay for API was conducted using High Performance Liquid Chromatography. Results were compared with pharmacopeia references. Visual examination of labels and confirmation of retention status of the brands with Pharmacy and Poisons Board retention register was carried out. RESULTS The samples were primarily of local origin (86.7%). On October 23, 2019, retention status of six of the fifteen brands documented were no longer listed in the Pharmacy and Poisons Board retention register. Of the 106 samples tested 70.6% and 86.8% were compliant with United States Pharmacopeia (USP) specifications for pH and API respectively while 84.0% adhered to packaging and labelling requirements. CONCLUSION This study has demonstrated that majority of co-trimoxazole suspensions tested were compliant with USP requirements. Additionally, it has provided evidence of poor quality co-trimoxazole medicines that could compromise treatment of infectious diseases in children. This emphasizes the need for regular quality assurance tests to ensure only quality medicines are in the market.
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Affiliation(s)
- Beatrice Njeri Irungu
- Kenya Medical Research Institute, Centre for Traditional Medicine and Drug Research, Nairobi, Kenya
- * E-mail:
| | - Lilian C. Koech
- Kenya Medical Research Institute, Centre for Traditional Medicine and Drug Research, Nairobi, Kenya
| | - Joyce M. Ondicho
- Kenya Medical Research Institute, Centre for Traditional Medicine and Drug Research, Nairobi, Kenya
| | - Lucia K. Keter
- Kenya Medical Research Institute, Centre for Traditional Medicine and Drug Research, Nairobi, Kenya
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Monahan C, Nag R, Morris D, Cummins E. Antibiotic residues in the aquatic environment - current perspective and risk considerations. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2021; 56:733-751. [PMID: 33979269 DOI: 10.1080/10934529.2021.1923311] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
Antimicrobial resistance is a major concern for human and animal health, projected to deteriorate with time and given current trends of antimicrobial usage. Antimicrobial use, particularly in healthcare and agriculture, can result in the release of antimicrobials into surface waters, promoting the development of antibiotic resistance in the environment, and potentially leading to human health risks. This study reviews relevant literature, and investigates current European and Irish antimicrobial usage trends in humans and animals, as well as potential pathways that antibiotics can take into surface waters following use. Reported levels in the aquatic environment are summarized, with particular focus on Ireland. There are relatively few studies examining Irish water bodies or sewage effluent for antibiotic residues, however, five antibiotics, namely azithromycin, ciprofloxacin, clarithromycin, metronidazole, and trimethoprim, have been measured in Irish waters, in concentrations predicted to select for resistance. Numerous isolates of multi-drug resistant bacteria have also been found in water bodies throughout Ireland and Europe. The value of risk assessment methodologies in understanding risks posed by antibiotic residues is reviewed including the advantages and disadvantages of specific approaches. Hazard quotient and bespoke Monte Carlo approaches are predominant risk assessment tools used to examine antimicrobial release and their complex pathways. This study highlights the need for monitoring of antimicrobial releases and the potential for resistance development, persistence and transmission while highlighting the role of risk assessment methodologies in assessing potential human and environmental health impacts.
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Affiliation(s)
- Ciaran Monahan
- School of Biosystems and Food Engineering, University College Dublin, Dublin, Ireland
| | - Rajat Nag
- School of Biosystems and Food Engineering, University College Dublin, Dublin, Ireland
| | - Dearbháile Morris
- Galway School of Medicine, National University of Ireland, Galway, Ireland
| | - Enda Cummins
- School of Biosystems and Food Engineering, University College Dublin, Dublin, Ireland
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Comparative Quality Evaluation of Selected Brands of Cefuroxime Axetil Tablets Marketed in the Greater Accra Region of Ghana. ScientificWorldJournal 2021; 2021:6659995. [PMID: 33927582 PMCID: PMC8049799 DOI: 10.1155/2021/6659995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
The ever-growing commercialization of poor-quality and substandard medicines, especially anti-infectives characterized by inadequate postmarket surveillance by stakeholders remains a major global health challenge, particularly in developing countries, where antibiotic drug resistance and its repercussions on human health remain dominant. This research sought to evaluate the pharmaceutical quality of six randomly selected brands of cefuroxime axetil tablets (250 mg) marketed in the Greater Accra region of Ghana. The selected brands were coded and subjected to both compendial and noncompendial tests. Statistical analysis and model-independent parameter (similarity factor, f2) were employed in analyzing the dissolution profiles of all the brands. All brands including the reference brand conformed to the pharmacopeial specifications for both compendial and noncompendial tests, indicating that they were of good quality. However, there were significant variations (p < 0.05) in the disintegration time amongst the various brands. All the brands had ƒ2 values > 50 indicating similarity of their drug release profiles with the innovator. Hence, all the sampled cefuroxime axetil brands can be considered as pharmaceutical equivalents to the innovator drug. These brands can, therefore, be used as a substitute for the innovator drug by physicians to patients in cases of unaffordability or unavailability of the innovator brand.
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Assi S, Arafat B, Lawson-Wood K, Robertson I. Authentication of Antibiotics Using Portable Near-Infrared Spectroscopy and Multivariate Data Analysis. APPLIED SPECTROSCOPY 2021; 75:434-444. [PMID: 32830991 PMCID: PMC8645310 DOI: 10.1177/0003702820958081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
Counterfeit medicines represent a global public health threat warranting the development of accurate, rapid, and nondestructive methods for their identification. Portable near-infrared (NIR) spectroscopy offers this advantage. This work sheds light on the potential of combining NIR spectroscopy with principal component analysis (PCA) and soft independent modelling of class analogy (SIMCA) for authenticating branded and generic antibiotics. A total of 23 antibiotics were measured "nondestructively" using a portable NIR spectrometer. The antibiotics corresponded to six different active pharmaceutical ingredients being: amoxicillin trihydrate and clavulanic acid, azithromycin dihydrate, ciprofloxacin hydrochloride, doxycycline hydrochloride, and ofloxacin. NIR spectra were exported into Matlab R2018b where data analysis was applied. The results showed that the NIR spectra of the medicines showed characteristic features that corresponded to the main excipient(s). When combined with PCA, NIR spectroscopy could distinguish between branded and generic medicines and could classify medicines according to their manufacturing sources. The PCA scores showed the distinct clusters corresponding to each group of antibiotics, whereas the loadings indicated which spectral features were significant. SIMCA provided more accurate classification over PCA for all antibiotics except ciprofloxacin which products shared many overlapping excipients. In summary, the findings of the study demonstrated the feasibility of portable NIR as an initial method for screening antibiotics.
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Affiliation(s)
- Sulaf Assi
- Pharmacy and Biomolecular Science,
Liverpool John Moores University, Liverpool, UK
| | - Basel Arafat
- Faculty of Health, Education, Medicine
and Social Care, Chelmsford, UK
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Chen HH, Higgins C, Laing SK, Bliese SL, Lieberman M, Ozawa S. Cost savings of paper analytical devices (PADs) to detect substandard and falsified antibiotics: Kenya case study. MEDICINE ACCESS @ POINT OF CARE 2021; 5. [PMID: 33834120 PMCID: PMC8026160 DOI: 10.1177/2399202620980303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Over 10% of antibiotics in low- and middle-income countries (LMICs) are
substandard or falsified. Detection of poor-quality antibiotics via the gold
standard method, high-performance liquid chromatography (HPLC), is slow and
costly. Paper analytical devices (PADs) and antibiotic paper analytical
devices (aPADs) have been developed as an inexpensive way to estimate
antibiotic quality in LMICs. Aim: To model the impact of using a rapid screening tools, PADs/aPADs, to improve
the quality of amoxicillin used for treatment of childhood pneumonia in
Kenya. Methods: We developed an agent-based model, ESTEEM (Examining Screening Technologies
with Economic Evaluations for Medicines), to estimate the effectiveness and
cost savings of incorporating PADs and aPADs in amoxicillin quality
surveillance in Kenya. We compared the current testing scenario (batches of
entire samples tested by HPLC) with an expedited HPLC scenario (testing
smaller batches at a time), as well as a screening scenario using PADs/aPADs
to identify poor-quality amoxicillin followed by confirmatory analysis with
HPLC. Results: Scenarios using PADs/aPADs or expedited HPLC yielded greater incremental
benefits than the current testing scenario by annually averting 586 (90%
uncertainty range (UR) 364–874) and 221 (90% UR 126–332) child pneumonia
deaths, respectively. The PADs/aPADs screening scenario identified and
removed poor-quality antibiotics faster than the expedited or regular HPLC
scenarios, and reduced costs significantly. The PADs/aPADs scenario resulted
in an incremental return of $14.9 million annually compared with the
reference scenario of only using HPLC. Conclusion: This analysis shows the significant value of PADs/aPADs as a medicine quality
screening and testing tool in LMICs with limited resources.
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Affiliation(s)
- Hui-Han Chen
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Colleen Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah K Laing
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sarah L Bliese
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.,Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Tie Y, Duchateau C, Van de Steene S, Mees C, De Braekeleer K, De Beer T, Adams E, Deconinck E. Spectroscopic techniques combined with chemometrics for fast on-site characterization of suspected illegal antimicrobials. Talanta 2020; 217:121026. [PMID: 32498874 DOI: 10.1016/j.talanta.2020.121026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
The threats of substandard and falsified (SF) antimicrobials, posed to public health, include serious adverse drug effects, treatment failures and even development of antimicrobial resistance. Next to these issues, it has no doubt that efficient methods for on-site screening are required to avoid that SF antimicrobials reach the patient or even infiltrate the legal supply chain. This study aims to develop a fast on-site screening method for SF antimicrobials using spectroscopic techniques (mid infrared, benchtop near infrared, portable near infrared and Raman spectroscopy) combined with chemometrics. 58 real-life illegal antimicrobials (claiming 18 different antimicrobials and one beta-lactamase inhibitor) confiscated by the Belgian Federal Agency for Medicines and Health Products (FAMHP) and 14 genuine antimicrobials were analyzed and used to build and validate models. Two types of models were developed and validated using supervised chemometric tools. One was used for the identification of the active pharmaceutical ingredients (APIs) by applying partial least squares-discriminant analysis (PLS-DA) and another one was used for the detection of non-compliant (overdosed or underdosed) samples by applying PLS-DA, k-nearest neighbors (k-NN) and soft independent modelling by class analogy (SIMCA). The best model capable of identifying amoxicillin and clavulanic acid (co-amoxiclav), azithromycin, co-trimoxazole and amoxicillin was based on the mid-infrared spectra with a correct classification rate (ccr) of 100%. The optimal model capable of detecting non-compliant samples within the combined group of amoxicillin and co-amoxiclav via SIMCA showed a ccr for the test set of 88% (7/8) using mid infrared or benchtop near infrared spectroscopy. The best model for detecting non-compliant samples within the group of amoxicillin via SIMCA was obtained using mid-infrared or Raman spectra, resulting in a ccr of 80% for the test set (4/5) and a ccr for calibration of 100%. For the group of co-amoxiclav, the optimal models showed a ccr of 100% for the detection of non-compliant samples by applying mid-infrared, benchtop near infrared or portable near infrared spectroscopy. Taken together, the obtained models, hyphenating spectroscopic techniques and chemometrics, enable to easily identify suspected SF antimicrobials and to differentiate non-compliant samples from compliant ones.
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Affiliation(s)
- Yaxin Tie
- Scientific Direction Chemical and Physical Health Risks, Section Medicines and Health Products, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium; KU Leuven, University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB 923, B-3000, Leuven, Belgium
| | - Céline Duchateau
- Scientific Direction Chemical and Physical Health Risks, Section Medicines and Health Products, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium; Université Libre de Bruxelles, Faculty of Pharmacy, RD3 - Pharmacognosy, Bioanalysis and Drug Research Unit, Boulevard du Triomphe, Campus Plaine, CP 205/06, 1050, Brussels, Belgium
| | - Shana Van de Steene
- Ghent University, Department of Pharmaceutical analysis, Laboratory of Pharmaceutical Process Analytical Technology, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Corenthin Mees
- Université Libre de Bruxelles, Faculty of Pharmacy, RD3 - Pharmacognosy, Bioanalysis and Drug Research Unit, Boulevard du Triomphe, Campus Plaine, CP 205/06, 1050, Brussels, Belgium
| | - Kris De Braekeleer
- Université Libre de Bruxelles, Faculty of Pharmacy, RD3 - Pharmacognosy, Bioanalysis and Drug Research Unit, Boulevard du Triomphe, Campus Plaine, CP 205/06, 1050, Brussels, Belgium
| | - Thomas De Beer
- Ghent University, Department of Pharmaceutical analysis, Laboratory of Pharmaceutical Process Analytical Technology, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Erwin Adams
- KU Leuven, University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, Herestraat 49, O&N2, PB 923, B-3000, Leuven, Belgium
| | - Eric Deconinck
- Scientific Direction Chemical and Physical Health Risks, Section Medicines and Health Products, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium.
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11
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Tabernero P, Swamidoss I, Mayxay M, Khanthavong M, Phonlavong C, Vilayhong C, Yeuchaixiong S, Sichanh C, Sengaloundeth S, Green MD, Newton PN. A random survey of the prevalence of falsified and substandard antibiotics in the Lao PDR. J Antimicrob Chemother 2020; 74:2417-2425. [PMID: 31049576 PMCID: PMC6640311 DOI: 10.1093/jac/dkz164] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patricia Tabernero
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Public Health Unit, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain
| | - Isabel Swamidoss
- U.S. Centers for Disease Control and Prevention (CDC), Division of Parasitic Diseases and Malaria, Atlanta, GA, USA
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Centre for Tropical Medicine & Global Health, Nuffield Research Building, Churchill Hospital, University of Oxford, Oxford, UK.,Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | | | - Chindaphone Phonlavong
- Bureau of Food and Drug Inspection (BFDI), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Chanthala Vilayhong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sengchanh Yeuchaixiong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Chanvilay Sichanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
| | - Sivong Sengaloundeth
- Food and Drug Department (FDD), Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Michael D Green
- U.S. Centers for Disease Control and Prevention (CDC), Division of Parasitic Diseases and Malaria, Atlanta, GA, USA
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine & Global Health, Nuffield Research Building, Churchill Hospital, University of Oxford, Oxford, UK.,Infectious Diseases Data Observatory, Nuffield Research Building, Churchill Hospital, University of Oxford, Oxford, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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12
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Country Income Is Only One of the Tiles: The Global Journey of Antimicrobial Resistance among Humans, Animals, and Environment. Antibiotics (Basel) 2020; 9:antibiotics9080473. [PMID: 32752276 PMCID: PMC7460298 DOI: 10.3390/antibiotics9080473] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022] Open
Abstract
Antimicrobial resistance (AMR) is one of the most complex global health challenges today: decades of overuse and misuse in human medicine, animal health, agriculture, and dispersion into the environment have produced the dire consequence of infections to become progressively untreatable. Infection control and prevention (IPC) procedures, the reduction of overuse, and the misuse of antimicrobials in human and veterinary medicine are the cornerstones required to prevent the spreading of resistant bacteria. Purified drinking water and strongly improved sanitation even in remote areas would prevent the pollution from inadequate treatment of industrial, residential, and farm waste, as all these situations are expanding the resistome in the environment. The One Health concept addresses the interconnected relationships between human, animal, and environmental health as a whole: several countries and international agencies have now included a One Health Approach within their action plans to address AMR. Improved antimicrobial usage, coupled with regulation and policy, as well as integrated surveillance, infection control and prevention, along with antimicrobial stewardship, sanitation, and animal husbandry should all be integrated parts of any new action plan targeted to tackle AMR on the Earth. Since AMR is found in bacteria from humans, animals, and in the environment, we briefly summarize herein the current concepts of One Health as a global challenge to enable the continued use of antibiotics.
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13
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Koech LC, Irungu BN, Ng'ang'a MM, Ondicho JM, Keter LK. Quality and Brands of Amoxicillin Formulations in Nairobi, Kenya. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7091278. [PMID: 32685520 PMCID: PMC7306854 DOI: 10.1155/2020/7091278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/04/2020] [Indexed: 11/17/2022]
Abstract
Antibiotics are among the most counterfeited anti-infectious medicines in developing countries. Amoxicillin is one of the commonly prescribed, affordable, and easily accessible antibiotic in Kenya. It is a broad-spectrum antibiotic hence commonly used in chemotherapy. This study sought to determine the quality and identify the various brands of amoxicillin and its combination amoxicillin/clavulanic acid marketed in Nairobi County. Nairobi is the capital city of Kenya, gateway for imports and exports, and the headquarters to most of the pharmaceutical distributors. Ten wards in Nairobi County representing different socioeconomic settings were purposively sampled for the study. A detailed questionnaire was used to collect background data on brands of amoxicillin and amoxicillin/clavulanic acid in the market. A total of 106 different brands were found in the market: 85 were imports while 21 were locally manufactured. Fifty-three samples were analyzed with reference to the United States Pharmacopoeia. Amoxicillin and clavulanic acid contents for oral suspensions were determined immediately after reconstitution and 7 days thereafter to determine their stability during the prescription period. On day seven, 23.1% (3 out of 13) of amoxicillin and 66.7% (8 out of 12) amoxicillin/clavulanic acid oral suspensions presented levels below recommended limits. Uniformity of weight for amoxicillin capsules noted 13.6% (3 out of 22) failure rate, while amoxicillin/clavulanic acid tablets complied. Potency determination for all amoxicillin capsules analyzed were within required limits, but amoxicillin/clavulanic acid tablets showed 33.3% (2 out of 6) noncompliance. For amoxicillin capsule and amoxicillin/clavulanic acid tablet dissolution tests, there was 10.5% (2 out of 19) and 50% (2 out of 4) noncompliance, respectively. Overall, 37.7% of the drugs analyzed failed to comply with the Pharmacopoeia. These results highlight the presence of poor-quality amoxicillin formulations in Nairobi County, affirming the need for regular postmarket surveillance to inform on the situation of antibiotic quality in the Kenyan market.
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Affiliation(s)
- Lilian C. Koech
- Department of Chemistry, School of Pure and Applied Sciences, Kenyatta University, P.O. Box 43844-00100, Nairobi, Kenya
- Center for Traditional Medicine and Drug Research, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Beatrice N. Irungu
- Center for Traditional Medicine and Drug Research, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Margaret M. Ng'ang'a
- Department of Chemistry, School of Pure and Applied Sciences, Kenyatta University, P.O. Box 43844-00100, Nairobi, Kenya
| | - Joyce M. Ondicho
- Center for Traditional Medicine and Drug Research, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Lucia K. Keter
- Center for Traditional Medicine and Drug Research, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
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14
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Tie Y, van Loock K, Deconinck E, Adams E. Evaluation of impurities and dissolution profiles of illegal antimicrobial drugs encountered in Belgium. Drug Test Anal 2019; 12:53-66. [PMID: 31454468 DOI: 10.1002/dta.2690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/07/2022]
Abstract
Substandard and falsified (SF) antimicrobials are gaining popularity in both developing and developed countries, posing a growing threat to public health. In general, the evaluation of SF antimicrobial drugs mainly focuses on the identification and quantification of the pharmaceutical active ingredients, ignoring other parameters of drug quality control. This study performed an in-depth characterization and hazard identification of suspected SF antimicrobial medicinal products encountered in Belgium. In this comprehensive evaluation, impurity tests and dissolution studies were carried out. The dissolution profiles of illegal SF antimicrobials were mathematically compared to their genuine counterparts using the f1 and f2 -factor. The results indicated that 17 out of 57 illegal samples contained higher than permitted amounts of impurities and clearly demonstrated low equivalences of dissolution profiles between SF antimicrobials and genuine products. The variations between tablets at the different time points of the dissolution curves were also higher for the SF medicines. Moreover, 11 out of 19 illegal samples failed to meet the dissolution criteria prescribed by the United States Pharmacopeia. As impurities may induce adverse reactions and improper dissolution patterns may be the cause of insufficient drug efficacy, aggravation of illness and even promotion of antimicrobial resistance can be expected.
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Affiliation(s)
- Yaxin Tie
- Scientific Direction Chemical and Physical Health Risks, Section Medicines and Health Products, Sciensano, Brussels, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, KU Leuven, University of Leuven, Leuven, Belgium
| | - Kevin van Loock
- Scientific Direction Chemical and Physical Health Risks, Section Medicines and Health Products, Sciensano, Brussels, Belgium
| | - Eric Deconinck
- Scientific Direction Chemical and Physical Health Risks, Section Medicines and Health Products, Sciensano, Brussels, Belgium
| | - Erwin Adams
- Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, KU Leuven, University of Leuven, Leuven, Belgium
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15
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Izadi E, Afshan G, Patel RP, Rao VM, Liew KB, Meor Mohd Affandi MMR, Kifli N, Suleiman A, Lee KS, Sarker MMR, Zaidi ST, Ming LC. Levofloxacin: Insights Into Antibiotic Resistance and Product Quality. Front Pharmacol 2019; 10:881. [PMID: 31474853 PMCID: PMC6702332 DOI: 10.3389/fphar.2019.00881] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 07/15/2019] [Indexed: 01/10/2023] Open
Abstract
Counterfeit and substandard medicines are recognized as one of serious threats to public health. The product quality of antibacterial medicine will compromise patients’ recovery and increase the chance of antibacterial resistance. The review aims to provide a summary of low quality levofloxacin issues and the risk factors as well as suggesting the aspects of product quality that need to be regulated strictly. Quality of the active ingredient, levofloxacin, has an important role to contribute to successful therapy. The poor quality of raw material, directly and indirectly, causes treatment failure as the presence of insufficient dose, mislabeled content, and poor dissolution characteristics can lead to lower bioavailability. Identifying and reporting these factors can potentially help in improving the quality of drug marketed in various developing countries and may also reduce the incidences of treatment failure. Dissolution test is used for testing the dissolution profiles and the rate of drug release from solid formulation such as oral formulations, thus providing information regarding the in vivo performance of a formulation and its bioequivalence. On the other hand, quality-testing procedures are used for comparing the quality of products.
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Affiliation(s)
- Ensieh Izadi
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Gull Afshan
- Department of Pulmonary Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Rahul P Patel
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | | | - Kai Bin Liew
- Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
| | | | - Nurolaini Kifli
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
| | - Amal Suleiman
- College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Kah Seng Lee
- Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
| | | | - Syed Tabish Zaidi
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia.,School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Long Chiau Ming
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia.,PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
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16
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Hamill H, Hampshire K, Mariwah S, Amoako-Sakyi D, Kyei A, Castelli M. Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context. Soc Sci Med 2019; 234:112369. [PMID: 31238286 PMCID: PMC6688066 DOI: 10.1016/j.socscimed.2019.112369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022]
Abstract
Where regulation is weak, medicine transactions can be characterised by uncertainty over the drug quality and efficacy, with buyers shouldering the greater burden of risk in exchanges that are typically asymmetric. Drawing on in-depth interviews (N = 220) and observations of medicine transactions, plus interviews with regulators (N = 20), we explore how people in Ghana negotiate this uncertainty and come to trust a medicine enough to purchase or ingest it. We identify two mechanisms - attempts to mitigate uncertainty through seeking observable signs of quality and attempts to reduce informational asymmetry - that underpin cognitive assessments of a medicine's trustworthiness. However, these 'cognitive' forms of trust assessment have limited traction where uncertainty is high and trustworthiness remains unknowable, so a third mechanism comes into play: one based on affective relationships within which transactions are socially embedded. Even these, however, cannot eliminate uncertainty, because of the dispersed and under-regulated nature of wider supply chains. In conclusion, we reflect on the need for careful research on actors' practices and decision-making across supply chains to inform more effective policy and regulation.
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Affiliation(s)
- Heather Hamill
- Department of Sociology, Oxford University, 42-43 Park End Street, Oxford, OX1 1JD, UK.
| | - Kate Hampshire
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK.
| | - Simon Mariwah
- Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana.
| | | | - Abigail Kyei
- The Ghana College of Nurses and Midwives, Pentecost University, Accra, Ghana.
| | - Michele Castelli
- Institute of Health and Society, Newcastle University The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
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17
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18
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Sherma J, Rabel F. Advances in the thin layer chromatographic analysis of counterfeit pharmaceutical products: 2008–2019. J LIQ CHROMATOGR R T 2019. [DOI: 10.1080/10826076.2019.1610772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Joseph Sherma
- Department of Chemistry, Lafayette College, Easton, PA, USA
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19
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Malhotra S. Essential medicines for noncommunicable diseases: “Quality variable”. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2019. [DOI: 10.4103/2468-8827.274464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Abugri J, Ansah F, Asante KP, Opoku CN, Amenga-Etego LA, Awandare GA. Prevalence of chloroquine and antifolate drug resistance alleles in Plasmodium falciparum clinical isolates from three areas in Ghana. AAS Open Res 2018; 1:1. [PMID: 32382694 PMCID: PMC7185243 DOI: 10.12688/aasopenres.12825.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 01/24/2023] Open
Abstract
Background: The emergence and spread of resistance in
Plasmodium falciparum to chloroquine (CQ) necessitated the change from CQ to artemisinin-based combination therapies (ACTs) as first-line drug for the management of uncomplicated malaria in Ghana in 2005. Sulphadoxine-pyrimethamine (SP) which was the second line antimalarial drug in Ghana, was now adopted for intermittent preventive treatment of malaria in pregnancy (IPTp). Methods: To examine the prevalence of molecular markers associated with CQ and antifolate drug resistance in Ghana, we employed restriction fragment length polymorphism polymerase chain reaction to genotype and compare single nucleotide polymorphisms (SNPs) in the
P. falciparum chloroquine resistance transporter (
pfcrt, PF3D7_0709000), multidrug resistance (
pfmdr1, PF3D7_0523000), bifunctional dihydrofolate reductase-thymidylate synthase (
pfdhfr, PF3D7_0417200) and dihydropteroate synthase (
pfdhps, PF3D7_0810800) genes. Parasites were collected from children with malaria reporting to hospitals in three different epidemiological areas of Ghana (Accra, Kintampo and Navrongo) in 2012-2013 and 2016-2017. Results: The overall prevalence of the CQ resistance-associated
pfcrt 76T allele was 8%, whereas
pfmdr1 86Y and 184F alleles were present in 10.2% and 65.1% of infections, respectively. The majority of the isolates harboured the antifolate resistance-associated
pfdhfr alleles 51I (83.4%), 59R (85.9 %) and 108N (90.5%).
Pfdhps 437G and 540E were detected in 90.6% and 0.7% of infections, respectively. We observed no significant difference across the three study sites for all the polymorphisms except for
pfdhps 437G
, which was more common in Accra compared to Kintampo for the 2016-2017 isolates. Across both
pfdhfr and
pfdhps genes, a large proportion (61%) of the isolates harboured the quadruple mutant combination (
I51R59N108/
G437). CQ resistance alleles decreased during the 12 years after CQ withdrawal, but an mediate SP resistance alleles increased. Conclusion: Surveillance of the prevalence of resistance alleles is necessary in monitoring the efficacy of antimalarial drugs.
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Affiliation(s)
- James Abugri
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana.,Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana.,Department of Applied Chemistry and Biochemistry, Faculty of Applied Sciences, University for Development Studies, Tamale, Ghana
| | - Felix Ansah
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana.,Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
| | - Kwaku P Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | | | - Lucas A Amenga-Etego
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana.,Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana.,Navrongo Health Research Centre, Navrongo, Ghana
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana.,Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
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21
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Abugri J, Ansah F, Asante KP, Opoku CN, Amenga-Etego LA, Awandare GA. Prevalence of chloroquine and antifolate drug resistance alleles in Plasmodium falciparum clinical isolates from three areas in Ghana. AAS Open Res 2018; 1:1. [PMID: 32382694 PMCID: PMC7185243 DOI: 10.12688/aasopenres.12825.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 11/25/2023] Open
Abstract
Background: The emergence and spread of resistance in Plasmodium falciparum to chloroquine (CQ) necessitated the change from CQ to artemisinin-based combination therapies (ACTs) as first-line drug for the management of uncomplicated malaria in Ghana in 2005. Sulphadoxine-pyrimethamine (SP) which was the second line antimalarial drug in Ghana, was now adopted for intermittent preventive treatment of malaria in pregnancy (IPTp). Methods: To examine the prevalence of molecular markers associated with CQ and antifolate drug resistance in Ghana, we employed restriction fragment length polymorphism polymerase chain reaction to genotype and compare single nucleotide polymorphisms (SNPs) in the P. falciparum chloroquine resistance transporter ( pfcrt, PF3D7_0709000), multidrug resistance ( pfmdr1, PF3D7_0523000), bifunctional dihydrofolate reductase-thymidylate synthase ( pfdhfr, PF3D7_0417200) and dihydropteroate synthase ( pfdhps, PF3D7_0810800) genes. Parasites were collected from children with malaria reporting to hospitals in three different epidemiological areas of Ghana (Accra, Kintampo and Navrongo) in 2012-2013 and 2016-2017. Results: The overall prevalence of the CQ resistance-associated pfcrt 76T allele was 8%, whereas pfmdr1 86Y and 184F alleles were present in 10.2% and 65.1% of infections, respectively. The majority of the isolates harboured the antifolate resistance-associated pfdhfr alleles 51I (83.4%), 59R (85.9 %) and 108N (90.5%). Pfdhps 437G and 540E were detected in 90.6% and 0.7% of infections, respectively. We observed no significant difference across the three study sites for all the polymorphisms except for pfdhps 437G , which was more common in Accra compared to Kintampo for the 2016-2017 isolates. Across both pfdhfr and pfdhps genes, a large proportion (61%) of the isolates harboured the quadruple mutant combination ( I 51 R 59 N 108/ G 437). CQ resistance alleles decreased during the 12 years after CQ withdrawal, but an mediate SP resistance alleles increased. Conclusion: Surveillance of the prevalence of resistance alleles is necessary in monitoring the efficacy of antimalarial drugs.
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Affiliation(s)
- James Abugri
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
- Department of Applied Chemistry and Biochemistry, Faculty of Applied Sciences, University for Development Studies, Tamale, Ghana
| | - Felix Ansah
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
| | - Kwaku P. Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | | | - Lucas A. Amenga-Etego
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
- Navrongo Health Research Centre, Navrongo, Ghana
| | - Gordon A. Awandare
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Legon, Ghana
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22
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Rasheed H, Höllein L, Holzgrabe U. Future Information Technology Tools for Fighting Substandard and Falsified Medicines in Low- and Middle-Income Countries. Front Pharmacol 2018; 9:995. [PMID: 30233373 PMCID: PMC6127459 DOI: 10.3389/fphar.2018.00995] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/13/2018] [Indexed: 12/26/2022] Open
Abstract
Substandard and falsified (SF) medicines have emerged as a global public health issue within the last two decades especially in low- and middle-income countries (LMICs). Serious consequences of this problem include a loss of trust and increased financial costs due to less disease control and more frequent complications during therapy. Of note, antimicrobial resistance is an additional long-term implication of poor-quality antimicrobials. This review covers information technology tools including medicines authentication tools (MAT) as mobile apps and messaging service, 2D barcoding approaches with drug safety alert systems, web based drug safety alerts, radiofrequency identification tags, databases to support visual inspection, digital aids to enhance the performance of quality evaluation kits, reference libraries for identification of falsified and substandard medicines, and quality evaluation kits based on machine learning for field testing. While being easy to access and simple to use, these initiatives are gaining acceptance in LMICs. Implementing 2D barcoding based on end-to-end verification and "Track and Trace" systems has emerged as a step toward global security in the supply chain. A breakthrough in web-based drug safety alert systems and data bases was the establishment of the Global Surveillance and Monitoring System by the World Health Organization in 2013. Future applications include concepts including "lab on a chip" and "paper analytical devices" and are claimed to be convenient and simple to use as well as affordable. The principles discussed herein are making profound impact in the fight against substandard and falsified medicines, offering cheap and accessible solutions.
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Affiliation(s)
- Huma Rasheed
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, Wuerzburg, Germany
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Ludwig Höllein
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, Wuerzburg, Germany
| | - Ulrike Holzgrabe
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, Wuerzburg, Germany
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23
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Boehle KE, Carrell CS, Caraway J, Henry CS. Paper-Based Enzyme Competition Assay for Detecting Falsified β-Lactam Antibiotics. ACS Sens 2018; 3:1299-1307. [PMID: 29943573 DOI: 10.1021/acssensors.8b00163] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Falsified and substandard antibiotics are a growing worldwide problem that leads to increased patient mortality and decreased trust in healthcare, and contributes to antimicrobial resistance. Monitoring falsified antibiotics is difficult because most falsified pharmaceuticals are most commonly found in developing countries, where detecting the active ingredient is difficult due to lack of access to complex instrumentation. Herein, we describe the development and optimization of a microfluidic paper-based analytical device (μPAD) to detect the active ingredient in the most falsified class of antibiotics, β-lactams. The assay is based on enzyme competition, making it the first demonstrated competitive enzyme assay reported in paper-based devices. The assay uses nitrocefin, a chromogenic substrate, to compete with β-lactam antibiotics in a reaction with β-lactamase. A yellow color indicates legitimate drugs, while a color change from yellow to red indicates falsified drugs. In addition to testing for the active ingredient, another section of the device was added to test the sample pH to further verify results and identify common falsified ingredients like aspirin or baking soda. Calibration curves for four different antibiotics, including cefazolin, have been generated making it the first paper-based device capable of detecting both cephalosporin and penicillin antibiotics. The μPAD has also been tested with common falsified ingredients and four antibiotics in tablet or injectable form, demonstrating its potential for in-field falsified antibiotic testing.
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24
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Paul P, Sänger-van de Griend C, Adams E, Van Schepdael A. Recent advances in the capillary electrophoresis analysis of antibiotics with capacitively coupled contactless conductivity detection. J Pharm Biomed Anal 2018; 158:405-415. [PMID: 29940496 DOI: 10.1016/j.jpba.2018.06.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/04/2023]
Abstract
This review describes briefly the high rate of counterfeiting of antimicrobial drugs with focus upon its immediate health consequences. The major part of this review encompasses accounts of the improvements achieved in the domain of miniaturization of capillary electrophoresis with capacitively coupled contactless conductivity detection (CE-C4D). The application of this principle into the development of portable devices as well as its application to counter the health-system-crippling phenomenon of counterfeit antibiotic formulations, are discussed in the context of developing countries.
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Affiliation(s)
- Prasanta Paul
- KU Leuven - University of Leuven, Pharmaceutical Analysis, Department of Pharmaceutical and Pharmacological Sciences, O&N2, PB 923, Herestraat 49, Leuven, 3000, Belgium
| | - Cari Sänger-van de Griend
- Department of Medicinal chemistry, Uppsala University, Husargatan 3, Uppsala, 751 23, Sweden; Kantisto BV, Callenburglaan 22, Baarn, 3742 MV, The Netherlands
| | - Erwin Adams
- KU Leuven - University of Leuven, Pharmaceutical Analysis, Department of Pharmaceutical and Pharmacological Sciences, O&N2, PB 923, Herestraat 49, Leuven, 3000, Belgium
| | - Ann Van Schepdael
- KU Leuven - University of Leuven, Pharmaceutical Analysis, Department of Pharmaceutical and Pharmacological Sciences, O&N2, PB 923, Herestraat 49, Leuven, 3000, Belgium.
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Schiavetti B, Wynendaele E, De Spiegeleer B, Mbinze GJ, Kalenda N, Marini R, Melotte V, Hasker E, Meessen B, Ravinetto R, Van der Elst J, Mutolo Ngeleka D. The Quality of Medicines Used in Children and Supplied by Private Pharmaceutical Wholesalers in Kinshasa, Democratic Republic of Congo: A Prospective Survey. Am J Trop Med Hyg 2018; 98:894-903. [PMID: 29313479 PMCID: PMC5930909 DOI: 10.4269/ajtmh.17-0732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Poor-quality medicines are a threat to public health in many low- and middle-income countries, and prospective surveys are needed to inform corrective actions. Therefore, we conducted a cross-sectional survey on a sample of products used for children and available in the private market in Kinshasa, Democratic Republic Congo: amoxicillin (AX) and artemether/lumefantrine (AL), powders for suspension, and paracetamol (PC) tablets 500 mg. Overall, 417 products were covertly purchased from 61 wholesalers. To obtain a representative sample, the products were weighted on their market shares and a subset of 239 samples was randomly extracted to undergo in-depth visual inspection locally, and they were chemically assessed at two accredited laboratories in Belgium. Samples were defined of “poor-quality” if they failed to comply with at least one specification of the International Pharmacopoeia (for AL) or United States Pharmacopoeia 37 (for AX and PC). Results are reported according to the Medicine Quality Assessment Reporting Guideline. The visual inspection detected nonconformities in the aspects of antimalarial powders for suspension, and poor-quality labels across all medicine types. According to chemical analysis, 27.2% samples were of poor quality and 59.5% of AL samples were underdosed in artemether. Poor quality was more frequent for locally manufactured antimalarials (83.3%, P = 0.021; 86.4%, P = 0.022) and PC (4.8%, P = 0.000). The poor quality of the surveyed products may decrease the treatment’s efficacy and favor the development of resistances to antimalarials. It is hoped that these findings may guide the corrective actions of the Democratic Republic of Congo Regulatory Authority, which was the main partner in the research.
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Affiliation(s)
| | - Evelien Wynendaele
- Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Bart De Spiegeleer
- Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Geremie J Mbinze
- Faculty of Pharmaceutical Sciences, Laboratory of Drug Analysis, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nicodème Kalenda
- Faculty of Pharmaceutical Sciences, Laboratory of Drug Analysis, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Roland Marini
- Department of Pharmacy, CIRM, Laboratory of Analytical Chemistry, University of Liege (ULg), Liege, Belgium
| | - Vera Melotte
- Belgian Technical Cooperation (BTC), Bruxelles, Belgium
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Meessen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Josiane Van der Elst
- Belgian Federal Agency for Medicines and Health Products (FAGG-AFMPS), Bruxelles, Belgium
| | - Daniel Mutolo Ngeleka
- Direction de la Pharmacie et du Médicament (DPM), Kinshasa, Democratic Republic of Congo
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Grech J, Robertson J, Thomas J, Cooper G, Naunton M, Kelly T. An empirical review of antimalarial quality field surveys: the importance of characterising outcomes. J Pharm Biomed Anal 2018; 147:612-623. [DOI: 10.1016/j.jpba.2017.04.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
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Pan H, Ba-Thein W. Diagnostic Accuracy of Global Pharma Health Fund Minilab™ in Assessing Pharmacopoeial Quality of Antimicrobials. Am J Trop Med Hyg 2018; 98:344-348. [PMID: 29141717 PMCID: PMC5928700 DOI: 10.4269/ajtmh.17-0289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 09/26/2017] [Indexed: 02/05/2023] Open
Abstract
Global Pharma Health Fund (GPHF) Minilab™, a semi-quantitative thin-layer chromatography (TLC)-based commercially available test kit, is widely used in drug quality surveillance globally, but its diagnostic accuracy is unclear. We investigated the diagnostic accuracy of Minilab system for antimicrobials, using high-performance liquid chromatography (HPLC) as reference standard. Following the Minilab protocols and the Pharmacopoeia of the People's Republic of China protocols, Minilab-TLC and HPLC were used to test five common antimicrobials (506 batches) for relative concentration of active pharmaceutical ingredients. The prevalence of poor-quality antimicrobials determined, respectively, by Minilab TLC and HPLC was amoxicillin (0% versus 14.9%), azithromycin (0% versus 17.4%), cefuroxime axetil (14.3% versus 0%), levofloxacin (0% versus 3.0%), and metronidazole (0% versus 38.0%). The Minilab TLC had false-positive and false-negative detection rates of 2.6% (13/506) and 15.2% (77/506) accordingly, resulting in the following test characteristics: sensitivity 0%, specificity 97.0%, positive predictive value 0, negative predictive value 0.8, positive likelihood ratio 0, negative likelihood ratio 1.0, diagnostic odds ratio 0, and adjusted diagnostic odds ratio 0.2. This study demonstrates unsatisfying diagnostic accuracy of Minilab system in screening poor-quality antimicrobials of common use. Using Minilab as a stand-alone system for monitoring drug quality should be reconsidered.
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Affiliation(s)
- Hui Pan
- Shantou-Oxford Clinical Research Unit, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - William Ba-Thein
- Shantou-Oxford Clinical Research Unit, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
- Address correspondence to William Ba-Thein, Shantou-Oxford Clinical Research Unit, Shantou University Medical College, 22 Xinling Road, Jinping, Shantou, Guangdong 515041, People’s Republic of China. E-mail:
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28
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Belew S, Suleman S, Wynendaele E, D’Hondt M, Kosgei A, Duchateau L, De Spiegeleer B. Quality of anthelminthic medicines available in Jimma Ethiopia. Acta Trop 2018; 177:157-163. [PMID: 29030043 DOI: 10.1016/j.actatropica.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/15/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022]
Abstract
Soil-transmitted helminthiasis and schistosomiasis are major public health problems in Ethiopia. Mass deworming of at-risk population using a single dose administration of 400mg albendazole (ABZ) or 500mg mebendazole (MBZ) for treatment of common intestinal worms and 40mg of praziquantel (PZQ) per kg body weight for treatment of schistosomiasis is one of the strategies recommended by World Health Organization (WHO) in order to control the morbidity of soil-transmitted helminthiasis and schistosomiasis. Since storage condition, climate, way of transportation and distribution route could all affect the quality of medicines, regular assessment by surveys is very critical to ensure the therapeutic outcome, to minimize risk of toxicity to the patient and resistance of parasites. Therefore, this study was conducted to assess the pharmaceutical quality of ABZ, MBZ and PZQ tablet brands commonly available in Jimma town (south west Ethiopia). Retail pharmacies (n=10) operating in Jimma town were selected using simple random sampling method. Samples of anthelminthic medicines available in the selected pharmacies were collected. Sample information was recorded and encompassed trade name, active ingredient name, manufacturer's name and full address, labeled medicine strength, dosage form, number of units per container, dosage statement, batch/lot number, manufacturing and expiry dates, storage information and presence of leaflets/package insert. Moreover, a first visual inspection was performed encompassing uniformity of color, uniformity of size, breaks, cracks, splits, embedded surface spots or visual contaminations. Finally, physico-chemical quality attributes investigated encompassed mass uniformity, quantity of active pharmaceutical ingredient (API), disintegration and dissolution, all following Pharmacopoeial test methods The physical characteristics of dosage form, packaging and labeling information of all samples complied with criteria given in the WHO checklists. The mass uniformity of tablets of each brand of ABZ, MBZ and PZQ complied with the pharmacopoeial specification limits, i.e no more than 2 individual masses >5% of average tablet weight, and none deviate by more than 10%. The quantity of APIs in all investigated tablet brands were within the 90-110% label claim (l.c.) limits, ranging between 95.05 and 110.09% l.c. Disintegration times were in line with the pharmacopoeial specification limit for immediate release (IR) tablets, ranging between 0.5 and 13min. However, the dissolution results (mean±SD, n=6) of one ABZ brand (i.e. Wormin®, Q=59.21±0.99% at 30min) and two PZQ brands (i.e. Bermoxel®, Q=63.43%±0.7 and Distocide®, Q=62.43%±1.67, at 75min) showed poor dissolution, failing the United States Pharmacopoeia (USP) dissolution specification limit.
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29
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Nabirova D, Schmid G, Yusupova R, Kantarbayeva M, Ismailov SI, Moffett D, Jähnke RWO, Nuorti JP. Assessment of the quality of anti-tuberculosis medicines in Almaty, Kazakhstan, 2014. Int J Tuberc Lung Dis 2017; 21:1161-1168. [PMID: 28911362 PMCID: PMC5696143 DOI: 10.5588/ijtld.17.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING In 2009, the World Health Organization (WHO) conducted a survey of the quality of four anti-tuberculosis drugs in the former Soviet Union countries. Kazakhstan had the highest proportion of substandard drugs. OBJECTIVE To assess the quality of anti-tuberculosis drugs used in Kazakhstan in 2014. DESIGN Fourteen anti-tuberculosis drugs from the Almaty Interdistrict TB Dispensary were randomly selected and screened for quality using Global Pharma Health Fund Minilab™ testing. First, the product and packaging were physically inspected to determine whether tablets/capsules were intact (i.e., whether they contained the full amount of the drug, and whether the packaging was genuine). Second, the tablets/capsules were dissolved in water to test whether they could be adequately absorbed by the body. Finally, semi-quantitive analyses were undertaken using thin-layer chromatography to verify the presence and concentration of the active pharmaceutical ingredient and to detect impurities. RESULTS We discovered no counterfeit medicines. However, 163 (19%) of the 854 anti-tuberculosis drugs sampled failed at least one of the three tests. These samples were found among 24/50 (48%) batches of 14 anti-tuberculosis drugs. CONCLUSION Our study identified a high proportion of poor-quality first- and second-line anti-tuberculosis drugs. Use of these medicines may lead to treatment failure and the development of drug resistance. Confirmatory testing should be performed to determine if they should be removed from the market.
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Affiliation(s)
- D Nabirova
- Centers for Disease Control and Prevention (CDC), Central Asia Regional Office, Almaty, Kazakhstan, School of Health Sciences, University of Tampere, Tampere, Finland
| | - G Schmid
- Tajik-Afghan Field Epidemiology Training Program, CDC, Dushanbe, Tajikistan
| | - R Yusupova
- Central Asia Field Epidemiology Training Program, AIDS Prevention and Control Center, Almaty
| | - M Kantarbayeva
- State Enterprise Scientific and Practical Centre for Epidemiological Inspection and Monitoring, Ministry of Health, Almaty
| | - S I Ismailov
- National Center of Tuberculosis Problems, Ministry of Health, Almaty, Kazakhstan, The Global Fund, Geneva, Switzerland
| | - D Moffett
- Centers for Disease Control and Prevention (CDC), Central Asia Regional Office, Almaty, Kazakhstan
| | - R W O Jähnke
- Global Pharma Health Fund, Merck, Darmstadt, Germany
| | - J P Nuorti
- School of Health Sciences, University of Tampere, Tampere, Finland
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Koczwara A, Dressman J. Poor-Quality and Counterfeit Drugs: A Systematic Assessment of Prevalence and Risks Based on Data Published From 2007 to 2016. J Pharm Sci 2017; 106:2921-2929. [PMID: 28549909 DOI: 10.1016/j.xphs.2017.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
Counterfeit drugs can hurt patients and harm the pharmaceutical industry. In 2006, the International Medical Products Anti-Counterfeiting Taskforce expressed a need to generate more and better data to calculate a worldwide prevalence of counterfeiting. This review analyzes field test data that were published in the time frame January 2007 to December 2016, were accessible via Pubmed, and which addressed the prevalence of counterfeit drugs. Based on the 41 studies identified, it is still not possible to make a reliable statement about the prevalence of counterfeit drugs due to the heterogeneity of the results. To make further progress in this area, both the quantity and quality of documented field tests should be increased. Without a differentiated analysis considering therapeutic class, source, and country of counterfeit drugs, it will remain difficult to identify the root causes of market infiltration and useful points of attack to combat them. Studies with high sample power and randomized sampling, packaging inspection, and detailed chemical analysis will be necessary to correctly identify (especially professional) counterfeit samples. The classification system presented in this review should help to calculate not only the prevalence of counterfeit drugs but also the risks to the patient associated with different types of counterfeited medicines.
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Affiliation(s)
- Andreas Koczwara
- Institute of Pharmaceutical Technology, Goethe University Frankfurt am Main, Frankfurt am Main, Hessen, Germany
| | - Jennifer Dressman
- Institute of Pharmaceutical Technology, Goethe University Frankfurt am Main, Frankfurt am Main, Hessen, Germany.
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31
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Lalani M, Kitutu FE, Clarke SE, Kaur H. Anti-malarial medicine quality field studies and surveys: a systematic review of screening technologies used and reporting of findings. Malar J 2017; 16:197. [PMID: 28506234 PMCID: PMC5433090 DOI: 10.1186/s12936-017-1852-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessing the quality of medicines in low-middle income countries (LMICs) relies primarily on human inspection and screening technologies, where available. Field studies and surveys have frequently utilized screening tests to analyse medicines sampled at the point of care, such as health care facilities and medicine outlets, to provide a snap shot of medicine quality in a specific geographical area. This review presents an overview of the screening tests typically employed in surveys to assess anti-malarial medicine quality, summarizes the analytical methods used, how findings have been reported and proposes a reporting template for future studies. METHODS A systematic search of the peer-reviewed and grey literature available in the public domain (including national and multi-national medicine quality surveys) covering the period 1990-2016 was undertaken. Studies were included if they had used screening techniques to assess the quality of anti-malarial medicines. As no standardized set of guidelines for the methodology and reporting of medicine quality surveys exist, the included studies were assessed for their standard against a newly proposed list of criteria. RESULTS The titles and abstracts of 4621 records were screened and only 39 were found to meet the eligibility criteria. These 39 studies utilized visual inspection, disintegration, colorimetry and Thin Layer Chromatography (TLC) either as components of the Global Pharma Health Fund (GPHF) MiniLab® or as individual tests. Overall, 30/39 studies reported employing confirmatory testing described in international pharmacopeia to verify the quality of anti-malarials post assessment by a screening test. The authors assigned scores for the 23 criteria for the standard of reporting of each study. CONCLUSIONS There is considerable heterogeneity in study design and inconsistency in reporting of field surveys of medicine quality. A lack of standardization in the design and reporting of studies of medicine quality increases the risk of bias and error, impacting on the generalizability and reliability of study results. The criteria proposed for reporting on the standard of studies in this review can be used in conjunction with existing medicine quality survey guidelines as a checklist for designing and reporting findings of studies. The review protocol has been registered with PROSPERO (CRD42015026782).
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Affiliation(s)
- Mirza Lalani
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Freddy Eric Kitutu
- Makerere University, Kampala, Uganda.,Uppsala University, Uppsala, Sweden
| | - Siân E Clarke
- London School of Hygiene and Tropical Medicine, London, UK
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32
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Nebot Giralt A, Schiavetti B, Meessen B, Pouget C, Caudron JM, Marchal B, Massat P, Thys S, Ravinetto R. Quality assurance of medicines supplied to low-income and middle-income countries: poor products in shiny boxes? BMJ Glob Health 2017; 2:e000172. [PMID: 28589013 PMCID: PMC5435257 DOI: 10.1136/bmjgh-2016-000172] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/07/2017] [Accepted: 02/11/2017] [Indexed: 11/15/2022] Open
Abstract
Objective In today's context of globalisation of pharmaceutical production and distribution, international and national procurement agencies play a de facto key role in defining the quality of medicines available in sub-Saharan Africa. We evaluated the compliance of a sample of pharmaceutical distributors active in sub-Saharan Africa with the standards of the WHO guideline ‘Model Quality Assurance System (WHO MQAS) for procurement agencies’, and we investigated factors favouring or hindering the adequate implementation of the guideline. Methods We used mixed-methods methodology to analyse quantitative and qualitative data. The quantitative study consisted of a retrospective secondary analysis of data collected by QUAMED (Quality Medicines for all), a partnership that pleads for universal access to quality-assured medicines. The qualitative survey consisted of formal and informal interviews with key informants. We adopted an embedded multiple-case study design. Findings Our analysis suggests that international distributors based in Europe perform, on average, better than sub-Saharan African distributors. However, some weaknesses are ubiquitous and concern critical processes, such as the initial selection of the products and the ongoing reassessment of their quality. This is due to several different factors: weak regulatory oversight, insufficient human/financial resources, weak negotiating power, limited judicial autonomy and/or lack of institutional commitment to quality. Conclusions Our findings suggest that pharmaceutical distributors active in sub-Saharan Africa generally do not apply stringent criteria for selecting products and suppliers. Therefore, product quality is not consistently assured but depends on the requirements of purchasers. While long-term solutions are awaited, the WHO MQAS guideline should be used as an evaluation and training tool to upgrade current standards.
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Affiliation(s)
- A Nebot Giralt
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - B Schiavetti
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - B Meessen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - B Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - P Massat
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - S Thys
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - R Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Post-marketing surveillance of generic amoxicillin using a microbiological assay and pharmacokinetic approach in rats. Int J Antimicrob Agents 2016; 48:753-756. [DOI: 10.1016/j.ijantimicag.2016.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/31/2016] [Accepted: 09/15/2016] [Indexed: 11/23/2022]
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34
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Fu Q, Su X, Hou Y, Li M, Li J, Sun J, He Z. Once-daily amoxicillin immediate- and extended-release bilayer tablets. POWDER TECHNOL 2016. [DOI: 10.1016/j.powtec.2016.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Routine quality control of medicines in developing countries: Analytical challenges, regulatory infrastructures and the prevalence of counterfeit medicines in Tanzania. Trends Analyt Chem 2016. [DOI: 10.1016/j.trac.2015.11.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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36
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Nayyar GML, Breman JG, Herrington JE. The global pandemic of falsified medicines: laboratory and field innovations and policy perspectives. Am J Trop Med Hyg 2015; 92:2-7. [PMID: 25897072 PMCID: PMC4455081 DOI: 10.4269/ajtmh.15-0221] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/10/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | - James E. Herrington
- Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Carey Business School, Baltimore, Maryland; Fogarty International Center, National Institutes of Health, Bethesda, Maryland; Gillings Global Gateway, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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