The comparison of the quality of selected brands of antibiotics in Tanzania sourced from different geographical regions

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.

Combating Alcohol Adduct Impurity in Immunosuppressant Drug Product Manufacturing: A Scientific Investigation for Enhanced Process Control

OBJECTIVE

This research aims to elucidate critical impurities in process validation batches of tacrolimus injection formulations, focusing on identification and characterization of previously unreported impurity at RRT 0.42, identified as the tacrolimus alcohol adduct. The potential root causes for the formation of new impurity was determined using structured risk assessment by cause and effect fishbone diagram. The primary objective was to propose mitigation plan and demonstrate the control of impurities with 6 month accelerated stability results in development batches.

METHODS

The investigation utilizes method validation and characterization studies to affirm the accuracy of quantifying the tacrolimus alcohol adduct. The research methodology employed different characterization techniques like rotational rheometer, ICP‒MS, MALDI-MS, 1H NMR, 13C NMR, and DEPT-135 NMR for structural elucidation. Additionally, the exact mass of the impurity is validated using electrospray ionization mass spectra.

RESULTS

Results indicate successful identification and characterization of the tacrolimus alcohol adduct. The study further explores the transformation of Tacrolimus monohydrate under various conditions, unveiling the formation of Tacrolimus hydroxy acid and proposing the existence of a novel degradation product, the Tacrolimus alcohol adduct. Six-month data from development lots utilizing Manufacturing Process II demonstrate significantly lower levels of alcohol adducts.

CONCLUSIONS

Manufacturing Process II, selectively locates Tacrolimus within the micellar core of HCO-60, this prevent direct contact of ethanol with Tacrolimus which minimizes impurity alcohol adduct formation. This research contributes to the understanding of tacrolimus formulations, offering ways to safeguard product integrity and stability during manufacturing and storage.

Research on storage stability differences between ceftriaxone sodium products

The conditions and mechanisms leading to stability differences between ceftriaxone sodium products were examined to ensure drug quality and efficacy. We used a combination of powder X-ray diffraction and thermogravimetric analysis to examine the differences between preparations for injection from different pharmaceutical processes to elucidate the changed processes by exposing samples to different humidity and high-temperature conditions. Water loss or absorption due to varying environmental humidity levels did not adversely affect the crystal structure, but could lead to the reversible redistribution of hepta-hydrate in the unit cell of generic products, causing its stability change. The irreversible distribution of hydrate may occur when generic drugs stored at 25 °C, whereas the brand-name products remained stable at 40 °C. Therefore, generic ceftriaxone sodium and its powder preparations would be acceptable by better controlled sealing and storing under cool conditions during storage period to meet the efficacy and stability.

Quality control and consistency evaluation of ceftriaxone sodium for injection

Ceftriaxone sodium for injection is an antibiotic used clinically. Here, we developed a strategy for evaluating the consistency of ceftriaxone sodium for injection. Comparison of the quality of the generic and original raw materials, and analysis of the production process revealed that the quality of the ceftriaxone sodium raw material is the most important factor affecting the quality of preparation, while the ceftriaxone sodium crystallization process is the key factor affecting the quality of raw materials. The solution clarity of the formulation, another key aspect, was addressed by controlling the leachable components found in the rubber closures used in the packaging. The time to achieve therapeutic efficacy of the preparation could be preliminarily evaluated by evaluating the rate of salt formation and the protein binding rate. Finally, the results of the tests (including water, pH, impurity profile and solution clarity) and assay were compared with the original preparation. On this basis, the critical quality attributes (CQAs) that reflect the quality of the product could be determined and a strategy for evaluating ceftriaxone sodium for injection was developed.

A strategy for population pharmaceutical quality assessment based on quality by design

From a regulatory perspective, drug quality consistency evaluation must concern different processes used for the same drug. In this study, an assessment strategy based on quality by design (QbD) was developed for population pharmaceutical quality evaluation. A descriptive analysis method based on QbD concept was first established to characterize the process by critical evaluation attributes (CEAs). Then quantitative analysis method based on an improved statistical process control (SPC) method was established to investigate the process indicators (PIs) in the process population, such as mean distribution, batch-to-batch difference and abnormal quality probability. After that rules for risk assessment were established based on the SPC limitations and parameters. Both the SPC parameters of the CEAs and the risk of PIs were visualized according to the interaction test results to obtain a better understanding of the population pharmaceutical quality. Finally, an assessment strategy was built and applied to generic drug consistency assessment, process risk assessment and quality trend tracking. The strategy demonstrated in this study could help reveal quality consistency from the perspective of process control and process risk, and further show the recent development status of domestic pharmaceutical production processes. In addition, a process risk assessment and population quality trend tracking provide data-based information for approval. Not only can this information serve as a further basis for decision-making by the regulatory authority regarding early warnings, but it can also reduce some avoidable adverse reactions. With continuous addition of data, dynamic population pharmaceutical quality is meaningful for emergencies and decision-making regarding drug regulation.

Evidence-based public policy making for medicines across countries: findings and implications for the future

Aim: Global expenditure on medicines is rising up to 6% per year driven by increasing prevalence of non-communicable diseases (NCDs) and new premium priced medicines for cancer, orphan diseases and other complex areas. This is difficult to sustain without reforms. Methods: Extensive narrative review of published papers and contextualizing the findings to provide future guidance. Results: New models are being introduced to improve the managed entry of new medicines including managed entry agreements, fair pricing approaches and monitoring prescribing against agreed guidance. Multiple measures have also successfully been introduced to improve the prescribing of established medicines. This includes encouraging greater prescribing of generics and biosimilars versus originators and patented medicines in a class to conserve resources without compromising care. In addition, reducing inappropriate antibiotic utilization. Typically, multiple measures are the most effective. Conclusion: Multiple measures will be needed to attain and retain universal healthcare.

Physicochemical Assessment of Branded and Generic Linezolid Injection from Different Pharmaceutical Manufacturers

Background:

Up to date, generic linezolid injections produced by Chinese manufacturers were not widely used in clinics in China. Quality evaluation of linezolid injections produced in China is a prerequisite, which has rarely been performed.

Objective:

This study aimed to evaluate the quality of branded and generic injections from different manufacturers and to provide a basis for quality control.

Methods:

In this study, the content of linezolid, related impurities and enantiomer of linezolid were determined by high-performance liquid chromatography. The content of glucose was determined by the iodine method. The insoluble particles and visible and sub-visible particles were determined by light blockage and lamp test, respectively. Osmotic pressure was determined by the freezing point depression method. The standard solution control method was used to check the color of the injection. Linezolid injections from different manufacturers were evaluated uniformly.

Results:

No significant difference was found in the content of linezolid, glucose, related impurities, visible particles, insoluble particles, pH value, and solution color between branded and generic drugs from different manufacturers in China.

Conclusion:

The quality of samples from different manufacturers is consistent. Although the physicochemical similarity does not guarantee the bioequivalence of studied branded and generic linezolid injections, the results provide references for further bioequivalence study. Generic injections offer more affordable treatment options for patients with infections than expensive branded drugs.

Assessment of Purity Parameters of Generic and Brand Name Losartan Potassium

Background:

Generic products must be bioequivalent to the innovator brand product. Nevertheless, in addition to meeting bioequivalence standards, attention must be paid to the content of the active substance and contaminants in generic drugs.

Objective:

This study compared the pharmaceutical quality of four generic losartan potassium formulations with the brand-name product: Cozaar®.

Methods:

The United States Pharmacopeia (USP) losartan potassium standard was used as reference material. The products tested (all 50 mg formulations) included four generic tablet formulations and the innovator brand product Cozaar®. Active substance content, organic impurities, and elemental impurities were assessed following the USP monograph for losartan potassium tablets and USP Chapter <233> on Elemental Impurities.

Results:

The results showed that three of the four generic products had low content of the active ingredient. The values ranged from 86.4 to 93.8%, being acceptable not below 95% of the labeled amount. Organic impurities were not detected in any of the products, and of the 13 elemental impurities tested, only four elements were detected. The elemental impurities Cr, Ni, Cu, and As were, however, in amounts within the limits established by the USP monograph. The only concern on the generic drugs analyzed was the low content of the active ingredient in 75% of the products.

Conclusion:

Since losartan is a drug of continuous use, lower content of the active ingredient may go unnoticed by the users of the generic product and entailed clinical consequences during long-term therapy.

Comparison of pharmaceutical quality of eight generic ganciclovir injections in China and Cymevene

To assess the pharmaceutical quality of eight commercially available generic products of ganciclovir injection produced in China with original brand product (Cymevene, Roche, Switzerland). Tests were performed according to China Pharmacopoeia 2015 and Import Drug Registration Standard introduced by CFDA. Items including characteristics of the packing and reconstituted solution, pH, visible particles, content of active and related substances, sterility and bacterial endotoxin were all carried out based on the standard laboratory operating rules and requirements. Seven of all tested domestically produced generics of ganciclovir for injection failed to reach the in vitro quality requirements in comparison with the original brand product Cymevene. Three generics failed to meet the standards for pH of an aqueous solution. One out of eight generic products fell outside the specifications for API content. All generics showed impurities, whose levels were generally greater than observed in the brand product. One generic product was identified an endotoxin contamination. In addition, six generic products failed to reach the quality requirements of water content, which should be under 3%. Most tested ganciclovir products failed to meet the pharmaceutical quality standards for original brand product. Important items like pH, endotoxin contamination, content of API and impurities could cause clinical attention, as they directly affect the therapeutic efficacy and patient tolerance.

Efficacy and safety of the switch of Triumeq® to generic (abacavir + lamivudine) + Tivicay®: data at 24 weeks

BACKGROUND

Generic drugs may help to support antiretroviral treatment. We want to assess the efficacy and safety at 24 weeks of the change of coformulated (abacavir + lamivudine + dolutegravir) to (abacavir + lamivudine) coformulated as a generic pharmaceutical specialty + dolutegravir.

METHODS

Between February and June 2017, switch from Triumeq® to a generic pharmaceutical specialty co-formulated tablet (abacavir + lamivudine) plus Tivicay® was made. Demographic, viroimmunological characteristics and the Charlson index were collected. Six months after switching, efficacy and safety were evaluated.

RESULTS

Switch was made in 93 patients, with a mean age of 47 years, after six months there were five patients (5.4%) with viral loads between 50 and 400 copies, no patient had viral loads of greater amount. There were 2 interruptions due to toxicity (2.15%), in relation to symptoms of the central nervous system. There were no differences in the amount of years with HAART, nor in the previous months with the STR regimen based on abacavir + lamivudine + dolutegravir, nor in the Charlson index. The effective saving in 2017 derived from the change in these 93 patients was € 125.512.

CONCLUSIONS

The change from a regimen of abacavir + lamivudine + dolutegravir seems to be safe and effective at 24 weeks.