1
|
Gabel J, Lächele M, Sander K, Gnegel G, Sunny-Abarikwu N, Ohazulike RE, Ngene J, Chioke JF, Häfele-Abah C, Heide L. Quality of Essential Medicines from Different Sources in Enugu and Anambra, Nigeria. Am J Trop Med Hyg 2024; 111:179-195. [PMID: 38740019 PMCID: PMC11229646 DOI: 10.4269/ajtmh.23-0837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/18/2024] [Indexed: 05/16/2024] Open
Abstract
This study investigated the quality of 13 essential medicines in the states of Enugu and Anambra, Nigeria. A total of 260 samples were purchased from licensed pharmaceutical manufacturers and wholesalers and from vendors in pharmaceutical markets with unclear licensing status. Samples were analyzed for identity, content, and dissolution according to the United States Pharmacopeia (USP) 42 monographs. Forty-five samples of this study could be examined for authenticity with the Mobile Authentication Service scheme of the Nigerian National Agency for Food and Drug Administration and Control. Out of all samples, 25.4% did not comply with the USP 42 specifications. Strikingly, 21 out of 22 dexamethasone tablet samples (95%) were out of specification (OOS). Nine out of 19 glibenclamide samples (47%) failed dissolution testing, and 7 out of 17 cotrimoxazole samples (41%) failed assay testing. Medicines against noncommunicable diseases showed a slightly higher percentage of OOS samples than anti-infectives (21.2% versus 17.6%). The rates of OOS samples were similar in medicines stated to be produced in Nigeria, India, and China but were very different between individual manufacturers from each of these countries of origin. Therefore, prequalification of products, manufacturers, and suppliers are very important for quality assurance in medicine procurement. Unexpectedly, the total proportions of OOS samples were similar from licensed vendors (25.2%) and from markets (25.5%). Four samples (1.5%), all collected in markets, were clearly falsified and did not contain the declared active pharmaceutical ingredients. The proportion of falsified medicines was found to be lower than frequently reported in the media for Nigeria.
Collapse
Affiliation(s)
- Julia Gabel
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Micha Lächele
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Katharina Sander
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Gesa Gnegel
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | | | - Juliet Ngene
- Faith-Based Central Medical Foundation (FBCMF), Enugu, Nigeria
| | | | | | - Lutz Heide
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| |
Collapse
|
2
|
Mahmoudi Meymand F, Takian A, Jaafaripooyan E. The challenges associated with the prevention of smuggling and counterfeiting health goods in Iran. BMC Public Health 2024; 24:1564. [PMID: 38862992 PMCID: PMC11165840 DOI: 10.1186/s12889-024-18637-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Smuggling health goods given the importance and critical nature of health services should be undeniably addressed and controlled by all countries. This issue is especially more widespread in developing countries with more damaging consequences. This paper therefore aims to identify and analyze the challenges of preventing smuggling of health goods in Iran. METHOD Within this qualitative study, we conducted face-to-face, semi-structured interviews with 30 purposefully recruited key informants and stakeholders in the detection, prevention, and combating of health goods smuggling. Each interview was analyzed thematically, using an inductive approach to generate codes, then categorized and presented in the form of main themes and sub-themes. Maxqda 11 assisted in coding, analysis, and data management. RESULTS Three main themes emerged representing the challenges of prevention of smuggling in Iran in the areas of anti-smuggling policy development, including categories of inefficient policy and plan, and failure to reach agenda; policy implementation; categorized into actors, resources and instruments, and implementation guarantee; and finally monitoring and evaluation; including, procedures and practices, and the role of surveyors. CONCLUSION Prevention of smuggling health goods proves to be a highly complex, challenging, and multi-faceted practice. Therefore, strengthening policy-making, regulatory frameworks, and facilitation functions about smuggling, counterfeiting, and corruption should be promoted in parallel.
Collapse
Affiliation(s)
- Farzaneh Mahmoudi Meymand
- Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
3
|
Mardikasari SA, Katona G, Sipos B, Csóka I. Essential considerations towards development of effective nasal antibiotic formulation: features, strategies, and future directions. Expert Opin Drug Deliv 2024; 21:611-625. [PMID: 38588551 DOI: 10.1080/17425247.2024.2341184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Intranasal antibiotic products are gaining popularity as a promising method of administering antibiotics, which provide numerous benefits, e.g. enhancing drug bioavailability, reducing adverse effects, and potentially minimizing resistance threats. However, some issues related to the antibiotic substances and nasal route challenges must be addressed to prepare effective formulations. AREAS COVERED This review focuses on the valuable points of nasal delivery as an alternative route for administering antibiotics, coupled with the challenges in the nasal cavity that might affect the formulations. Moreover, this review also highlights the application of nasal delivery to introduce antibiotics for local therapy, brain targeting, and systemic effects that have been conducted. In addition, this viewpoint provides strategies to maintain antibiotic stability and several crucial aspects to be considered for enabling effective nasal formulation. EXPERT OPINION In-depth knowledge and understanding regarding various key considerations with respect to the antibiotic substances and nasal route delivery requirement in preparing effective nasal antibiotic formulation would greatly improve the development of nasally administered antibiotic products, enabling better therapeutic outcomes of antibiotic treatment and establishing appropriate use of antibiotics, which in turn might reduce the chance of antibiotic resistance and enhance patient comfort.
Collapse
Affiliation(s)
- Sandra Aulia Mardikasari
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
- Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Gábor Katona
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Bence Sipos
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Ildikó Csóka
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| |
Collapse
|
4
|
Anjulo H, Birhane W, Hymete A, Ashenef A. Quality Assessment of Selected Essential Antimicrobial Drugs from Drug Retail Outlets of Selected Cities in Eastern Ethiopia. Am J Trop Med Hyg 2024; 110:596-608. [PMID: 38350137 PMCID: PMC10919192 DOI: 10.4269/ajtmh.23-0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/12/2023] [Indexed: 02/15/2024] Open
Abstract
The prevalence of substandard and falsified (SF) antimicrobial drugs is increasing around the globe. This poses a great concern for the healthcare system. The consumption of SF antimicrobial drugs has the potential to result in treatment failure, emergence and development of antimicrobial resistance, and ultimately a rise in mortality rate. The objective of this study was to assess the quality of four commonly used antimicrobials marketed in the cities of Dire Dawa and Jijiga and the town of Togo-Wuchale, which have high potential for illegal drug trade activities in Ethiopia because they are located near the border with Somalia. A total of 54 brands/samples of amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, and norfloxacin formulations were collected covertly from 43 facilities using a convenience sampling strategy from March 16 to March 29, 2022. The samples were first screened using Global Pharma Health Fund (GPHF)-Minilab protocols and then analyzed using U.S. Pharmacopoeial and British Pharmacopoeia official methods. The quality evaluation detected no falsified product; however, it showed that 14.3% of the samples failed the GPHF-Minilab screening test semiquantitatively. Overall, 22.2% of the products analyzed did not meet any of pharmacopoeial specifications assessed: 13%, 12.2%, and 11.1% of the products failed in assay, dissolution, and weight variation, respectively. Additionally, 56.3% of amoxicillin samples, 60% of amoxicillin/clavulanate, 20% of ciprofloxacin, and 54.5% of norfloxacin samples were found to be pharmaceutically nonequivalent with their respective comparator products regarding dissolution profiles. The study showed the presence of substandard antimicrobial medicines in the eastern Ethiopian market.
Collapse
Affiliation(s)
- Hailu Anjulo
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Food and Drug Authority, Addis Ababa, Ethiopia
| | - Worku Birhane
- Department of Pharmacy, College of Health Science, Debremarkos University, Debremarkos, Ethiopia
| | - Ariaya Hymete
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayenew Ashenef
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
5
|
Sorato MM, Davari M, Kebriaeezadeh A. Improving access to medicines to reduce marketing and use of substandard and falsified medicines in Africa: Scoping review. THE JOURNAL OF MEDICINE ACCESS 2024; 8:27550834241236598. [PMID: 38476401 PMCID: PMC10929061 DOI: 10.1177/27550834241236598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
Background Both constrained access to essential medicines and combatting marketing of substandard and falsified (SF) medicines are unmet health sector goals in Africa. Objective To answer the question of how improved access can reduce the continuous surge of SF medicines in Africa. Design We conducted a scoping review based on standard protocol. Methods We searched articles published in the English language from PubMed/Medline, Cochrane Library, Embase, Scopus, Web of Science, and Google Scholar by using a systematic search query. Results Seventy-one articles were included in this review. Access to quality essential medicines is still a major problem in developing countries in Africa and will continue as a threat for the next decade of health care. Ensuring access to quality medicines and preventing SF medicines in Africa need a systematic approach to address their underlying causes. Failure to ensure access to medicines is the major reason for the availability of SF medicines. Improving access to quality medicines can reduce SF medicine marketing and use. Manipulating the entire supply chain for efficiency, avoiding trade agreements that could reduce access, using compulsory licensing provisions, and pharmaceutical price control, providing incentives for drug development, and promoting rational use of medicines can improve access. Conclusion Ensuring access to medicines and preventing SF medicine marketing cannot be achieved in the planned period in developing countries in Africa unless a comprehensive strategy is used. Improving access to quality medicines can reduce SF medicine marketing and use, that is, ensuring access through uninterrupted supply, improved efficiency, enhanced local production, preventing SF medicine entry, improved medication use system, and improved affordability. Therefore, it is essential to improve supply chain capability, address challenges of the supply chain, improve leadership and governance, establish country-specific anti-counterfeiting and anti-substandardization committees, and collaborate with all relevant stakeholders.
Collapse
Affiliation(s)
- Mende Mensa Sorato
- Department of Pharmacy, College of Medicine, Komar University of Science and Technology, Sulaimaniyah, Iraq
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Muloi DM, Kurui P, Sharma G, Ochieng L, Nganga F, Gudda F, Muthini JM, Grace D, Dione M, Moodley A, Muneri C. Antibiotic quality and use practices amongst dairy farmers and drug retailers in central Kenyan highlands. Sci Rep 2023; 13:23101. [PMID: 38155204 PMCID: PMC10754936 DOI: 10.1038/s41598-023-50325-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023] Open
Abstract
Understanding antibiotic use in dairy systems is critical to guide antimicrobial stewardship programs. We investigated antibiotic use practices in small-holder dairy farms, antibiotic quality, and antimicrobial resistance (AMR) awareness among veterinary drug retailers in a mixed farming community in the central Kenyan highlands. Data were collected from 248 dairy farms and 72 veterinary drug stores between February 2020 and October 2021. A scale was developed to measure knowledge about AMR and antibiotic use using item response theory, and regression models were used to evaluate factors associated with antibiotic use and AMR knowledge. The active pharmaceutical ingredient (API) content of 27 antibiotic samples was determined using high-performance liquid chromatography (HPLC). The presence and levels of 11 antibiotic residues in 108 milk samples collected from the study farms were also investigated using liquid chromatography tandem mass spectrometry (LC-MS/MS). Almost all farms (98.8%, n = 244) reported using antibiotics at least once in the last year, mostly for therapeutic reasons (35.5%). The most used antibiotics were tetracycline (30.6%), penicillin (16.7%), and sulfonamide (9.4%), either individually or in combination, and predominantly in the injectable form. Larger farm size (OR = 1.02, p < 0.001) and history of vaccination use (OR = 1.17, p < 0.001) were significantly associated with a higher frequency of antibiotic use. Drug retailers who advised on animal treatments had a significantly higher mean knowledge scores than those who only sold drugs. We found that 44.4% (12/27) of the tested antibiotics did not meet the United States Pharmacopeial test specifications (percentage of label claim). We detected nine antibiotics in milk, including oxytetracycline, sulfamethoxazole, and trimethoprim. However, only three samples exceeded the maximum residue limits set by the Codex Alimentarius Commission. Our findings indicate that antibiotics of poor quality are accessible and used in small-holder dairy systems, which can be found in milk. These results will aid future investigations on how to promote sustainable antibiotic use practices in dairy systems.
Collapse
Affiliation(s)
- Dishon M Muloi
- Animal and Human Health Department, International Livestock Research Institute, Nairobi, Kenya.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK.
| | - Peter Kurui
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, Nairobi, Kenya
| | - Garima Sharma
- Animal and Human Health Department, International Livestock Research Institute, Nairobi, Kenya
| | - Linnet Ochieng
- Animal and Human Health Department, International Livestock Research Institute, Nairobi, Kenya
| | - Fredrick Nganga
- Animal and Human Health Department, International Livestock Research Institute, Nairobi, Kenya
| | - Fredrick Gudda
- Animal and Human Health Department, International Livestock Research Institute, Nairobi, Kenya
| | - John Maingi Muthini
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, Nairobi, Kenya
| | - Delia Grace
- Animal and Human Health Department, International Livestock Research Institute, Nairobi, Kenya
- Natural Resources Institute, University of Greenwich, Kent, UK
| | - Michel Dione
- Animal and Human Health Department, International Livestock Research Institute, Dakar, Senegal
| | - Arshnee Moodley
- Animal and Human Health Department, International Livestock Research Institute, Nairobi, Kenya.
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark.
| | - Caroline Muneri
- Department of Veterinary Surgery, Theriogenology and Medicine, Egerton University, Njoro, Kenya
| |
Collapse
|
7
|
Tack B, Vita D, Ntangu E, Ngina J, Mukoko P, Lutumba A, Vangeluwe D, Toelen J, Allegaert K, Lunguya O, Ravinetto R, Jacobs J. Challenges of Antibiotic Formulations and Administration in the Treatment of Bloodstream Infections in Children Under Five Admitted to Kisantu Hospital, Democratic Republic of Congo. Am J Trop Med Hyg 2023; 109:1245-1259. [PMID: 37903440 DOI: 10.4269/ajtmh.23-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023] Open
Abstract
Severe bacterial infections in children need prompt, appropriate antibiotic treatment. We report challenges observed within a prospective, cohort study on antibiotic efficacy in non-typhi Salmonella bloodstream infection (NCT04850677) in Kisantu district hospital (Democratic Republic of Congo). Children (aged > 28 days to < 5 years) admitted with suspected bloodstream infection (August 1, 2021 through July 31, 2022) were enrolled and followed until day 3 or discharge for non-typhi Salmonella patients. Antibiotics were administered to 98.4% (1,838/1,867) of children, accounting for 2,296 antibiotic regimens (95.7% intravenous, 4.3% oral). Only 78.3% and 61.8% of children were, respectively, prescribed and administered antibiotics on the admission day. At least one dose was not administered in 3.6% of children, mostly because of mismatch of the four times daily cefotaxime schedule with the twice-daily administration rounds. Inappropriate intravenous administration practices included multidose use, air-venting, and direct injection instead of perfusion. There was inaccurate aliquoting in 18.0% (32/178) of intravenous ciprofloxacin regimens, and thus administered doses were > 16% below the intended dose. Dosing accuracy of oral suspensions was impaired by lack of instructions for reconstitution, volume indicators, and/or dosing devices. Adult-dose tablets were split without/beyond scoring lines in 84.4% (27/32) of tablets. Poor availability and affordability of age-appropriate oral formulations contributed to low proportions of intravenous-to-oral switch (33.3% (79/237) of non-typhi Salmonella patients). Other quality issues included poor packaging, nonhomogeneous suspensions, and unsafe water for reconstitution. In conclusion, poor antibiotic products (no age-appropriate formulations, poor quality and access), processes (delayed prescription/administration, missed doses), and practices (inaccurate doses, [bio]safety risks) must be urgently addressed to improve pediatric antibiotic treatment.
Collapse
Affiliation(s)
- Bieke Tack
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
- Department of Pediatrics, KU Leuven University Hospitals Leuven, Belgium
| | - Daniel Vita
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | - Emmanuel Ntangu
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | - Japhet Ngina
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | - Pathy Mukoko
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | - Adèle Lutumba
- Saint Luc Hôpital Général de Référence Kisantu, Democratic Republic of Congo
| | | | - Jaan Toelen
- Department of Pediatrics, KU Leuven University Hospitals Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Democratic Republic of Congo
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| |
Collapse
|
8
|
Macé C, Nikiema JB, Sarr OS, Ciza Hamuli P, Marini RD, Neci RC, Bourdillon Esteve P, Ravinetto R. The response to substandard and falsified medical products in francophone sub-Saharan African countries: weaknesses and opportunities. J Pharm Policy Pract 2023; 16:117. [PMID: 37803394 PMCID: PMC10557312 DOI: 10.1186/s40545-023-00628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023] Open
Abstract
Assuring the quality of medical products manufactured, imported or distributed in francophone sub-Saharan Africa remains a challenge, despite positive signals like the growing engagement in the benchmarking of regulatory authorities and -particularly- in the establishment of the African Medicines Agency. In this short report, we describe the existing activities to prevent, detect and respond to substandard and falsified products (SF) in this region, either through African multilateral organizations and initiatives led by the World Health Organization, or through the contribution of other stakeholders, such as local universities and procurement agencies. We underline that these emerging local stakeholders may play a pivotal role to guide and inform the national regulatory authorities about the prevalence and patterns of SF medical products, complementing the market surveillance and control, and building awareness of the importance of pharmaceutical quality assurance for public health.
Collapse
Affiliation(s)
| | | | - Omar Serigne Sarr
- University of Dakar Cheikh Anta Diop, Dakar, Senegal
- Senegalese Drug Regulatory Agency, Dakar, Senegal
| | - Patient Ciza Hamuli
- Faculty of Pharmaceutical Sciences, LACOMEDA, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Roland Djang'eing'a Marini
- CIRM, VibraSante Hub, Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, University of Liege, Liege, Belgium
| | | | - Pernette Bourdillon Esteve
- Incidents and Substandard/Falsified Medical Products Team, World Health Organization (WHO), Geneva, Switzerland
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, 2000, Antwerp, Belgium.
- School of Public Health, University of the Western Cape, Cape Town, South Africa.
| |
Collapse
|
9
|
Tshilumba PM, Ilangala AB, Mbinze Kindenge J, Kasongo IM, Kikunda G, Rongorongo E, Impele AB, Marini Djang’eing’a R, Ndoumba JBK. Detection of Substandard and Falsified Antibiotics Sold in the Democratic Republic of the Congo Using Validated HPLC and UV-Visible Spectrophotometric Methods. Am J Trop Med Hyg 2023; 109:480-488. [PMID: 37339757 PMCID: PMC10397439 DOI: 10.4269/ajtmh.23-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/11/2023] [Indexed: 06/22/2023] Open
Abstract
The access to afford safe, effective, and genuine medications is a major challenge for people in low- to middle-income countries. This study aimed at developing and validating simple, accurate, and inexpensive analytical liquid chromatography and ultraviolet-visible spectrophotometric methods to ensure quality control of antibiotics sold in formal and informal pharmaceutical markets. It focused on four antibiotics (azithromycin [AZT], cefadroxil [CFD], cefixime [CFX], and erythromycin [ERH]) used to treat infectious diseases in the region of Haut-Katanga in the Democratic Republic of the Congo (DRC). The total error strategy (accuracy profile) matching with the validation requirements of International Council on Harmonization was used for the validation. The validation results showed that three analytical methods of AZT, CFD, and ERH were validated according to the accuracy profile obtained, whereas the proposed method of CFX was not validated. Therefore, the United State Pharmacopoeia method permitted to quantify CFX samples. The dosage intervals ranged from 25 to 75 µg/mL for CFD, from 750 to 1,500 µg/mL for AZT, and from 500 to 750 µg/mL for ERH. The application of the validated method to samples collected (N = 95) allowed the detection of 25% substandard antibiotics with a rate of poor quality much higher in the informal circuit compared with the formal one (54% versus 11%; P < 0.05). The routine application of these methods will strengthen the quality control of drugs marketed in DRC. This study gives evidence for the availability of poor-quality antibiotics in the country, requiring the immediate attention of the national medicine regulatory authority.
Collapse
Affiliation(s)
- Pierrot Mwamba Tshilumba
- Department of Drug Analysis and Galenic, LAMEDA, University of Lubumbashi (UNILU), Lubumbashi, Democratic Republic of the Congo
| | - Ange B. Ilangala
- Laboratory of Pharmaceutics and Phytopharmaceutical Drug Development, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jeremie Mbinze Kindenge
- Laboratory of Pharmaceutics and Phytopharmaceutical Drug Development, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Isaac Mutshitshi Kasongo
- Department of Drug Analysis and Galenic, LAMEDA, University of Lubumbashi (UNILU), Lubumbashi, Democratic Republic of the Congo
| | - Guelord Kikunda
- Department of Drug Analysis and Galenic, LAMEDA, University of Lubumbashi (UNILU), Lubumbashi, Democratic Republic of the Congo
| | - Elie Rongorongo
- Department of Drug Analysis and Galenic, LAMEDA, University of Lubumbashi (UNILU), Lubumbashi, Democratic Republic of the Congo
| | - Alex Bokanya Impele
- Department of Drug Analysis and Galenic, LAMEDA, University of Lubumbashi (UNILU), Lubumbashi, Democratic Republic of the Congo
| | - Roland Marini Djang’eing’a
- Department of Pharmacy, Laboratory of Pharmaceutical Analytical Chemistry, University of Liege (ULiège), CIRM, VibraSante Hub, Liege, Belgium
- Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Jean-Baptiste Kalonji Ndoumba
- Department of Drug Analysis and Galenic, LAMEDA, University of Lubumbashi (UNILU), Lubumbashi, Democratic Republic of the Congo
| |
Collapse
|
10
|
Sono TM, Yeika E, Cook A, Kalungia A, Opanga SA, Acolatse JEE, Sefah IA, Jelić AG, Campbell S, Lorenzetti G, Ul Mustafa Z, Marković-Peković V, Kurdi A, Anand Paramadhas BD, Rwegerera GM, Amu AA, Alabi ME, Wesangula E, Oluka M, Khuluza F, Chikowe I, Fadare JO, Ogunleye OO, Kibuule D, Hango E, Schellack N, Ramdas N, Massele A, Mudenda S, Hoxha I, Moore CE, Godman B, Meyer JC. Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance. Expert Rev Anti Infect Ther 2023; 21:1025-1055. [PMID: 37740561 DOI: 10.1080/14787210.2023.2259106] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. AREAS COVERED A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. EXPERT OPINION ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.
Collapse
Affiliation(s)
- Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Saselamani Pharmacy, Saselamani, South Africa
| | - Eugene Yeika
- Programs coordinator/Technical supervisor for HIV/Malaria, Delegation of Public Health, Cameroon
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Sylvia A Opanga
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Ana Golić Jelić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Vanda Marković-Peković
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Amanj Kurdi
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Bene D Anand Paramadhas
- Department of Health Services Management, Central Medical Stores, Ministry of Health, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
- DestinyMedical and Research Solutions Proprietary Limited, Gaborone, Botswana
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Kingdom of Eswatini
| | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences,University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Evelyn Wesangula
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Margaret Oluka
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Uganda
| | - Ester Hango
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, SouthAfrica
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, School of Veterinary Meicine, University of Zambia, Lusaka, Zambia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Brian Godman
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho HealthSciences University, Garankuwa, Pretoria, South Africa
| |
Collapse
|
11
|
Barrett R. A cross-sectional study on substandard and falsified medicines (fake or counterfeit drugs) in UK pharmacies during the COVID-19 pandemic. Expert Opin Drug Saf 2023; 22:1289-1299. [PMID: 36374122 DOI: 10.1080/14740338.2023.2147922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Failure of the Falsified Medicines Directive (FMD) in the UK could mean that substandard and falsified medicines (SFs) enter the supply chain. Does this risk patients' health? Readiness to implement FMD, and prevalence of SFs vs. regulator detection were assessed. RESEARCH DESIGN AND METHODS A total of 12,040 primary care pharmacies across England were invited (April 2021-March 2022). Respondent postcodes were used to extract deprivation scores. Information request was placed with the medicine's agency. Survey findings were used to calculate probability and power of a simulated trial. RESULTS A total of 208 participants responded: Of the seven who identified SFs, all but one reported it; 61% were ready to implement FMD, 74.1% had adequate resources, 54.8% expected improved patient safety, and 17.8% had ever reported SFs. SFs were prevalent in deprived areas. Bayesian simulation shows 438 (p = 0.030) incidences with a 3% probability of SFs prevalence. The agency identified 15,238 SFs units in the supply chain (2019 and 2020). Results are credible, reliable, and generalisable, with corroborated longitudinal persistence. CONCLUSIONS FMD or equivalent processes need to be urgently reinstated. Deprived children may be more affected. Pharmacists are worried about liability. All health consultations should assess safety, and effectiveness of medicines. Findings should inform policy, systems planning, surveillance, and evaluations.
Collapse
Affiliation(s)
- Ravina Barrett
- Pharmacy Practice, School of Applied Sciences, Cockcroft Building, University of Brighton, Brighton, UK
| |
Collapse
|
12
|
Ivanova B. Stochastic Dynamic Mass Spectrometric Quantitative and Structural Analyses of Pharmaceutics and Biocides in Biota and Sewage Sludge. Int J Mol Sci 2023; 24:6306. [PMID: 37047279 PMCID: PMC10094044 DOI: 10.3390/ijms24076306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/17/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
Mass spectrometric innovations in analytical instrumentation tend to be accompanied by the development of a data-processing methodology, expecting to gain molecular-level insights into real-life objects. Qualitative and semi-quantitative methods have been replaced routinely by precise, accurate, selective, and sensitive quantitative ones. Currently, mass spectrometric 3D molecular structural methods are attractive. As an attempt to establish a reliable link between quantitative and 3D structural analyses, there has been developed an innovative formula [DSD″,tot=∑inDSD″,i=∑in2.6388.10-17×Ii2¯-Ii¯2] capable of the exact determination of the analyte amount and its 3D structure. It processed, herein, ultra-high resolution mass spectrometric variables of paracetamol, atenolol, propranolol, and benzalkonium chlorides in biota, using mussel tissue and sewage sludge. Quantum chemistry and chemometrics were also used. Results: Data on mixtures of antibiotics and surfactants in biota and the linear dynamic range of concentrations 2-80 ng.(mL)-1 and collision energy CE = 5-60 V are provided. Quantitative analysis of surfactants in biota via calibration equation ln[D″SD] = f(conc.) yields the exact parameter |r| = 0.99991, examining the peaks of BAC-C12 at m/z 212.209 ± 0.1 and 211.75 ± 0.15 for tautomers of fragmentation ions. Exact parameter |r| = 1 has been obtained, correlating the theory and experiments in determining the 3D molecular structures of ions of paracetamol at m/z 152, 158, 174, 301, and 325 in biota.
Collapse
Affiliation(s)
- Bojidarka Ivanova
- Lehrstuhl für Analytische Chemie, Institut für Umweltforschung, Fakultät für Chemie und Chemische Biologie, Universität Dortmund, Otto-Hahn-Straße 6, 44221 Dortmund, Nordrhein-Westfalen, Germany
| |
Collapse
|
13
|
Waffo Tchounga CA, Sacré PY, Ciza Hamuli P, Ngono Mballa R, De Bleye C, Ziemons E, Hubert P, Marini Djang’eing’a R. Prevalence of Poor Quality Ciprofloxacin and Metronidazole Tablets in Three Cities in Cameroon. Am J Trop Med Hyg 2023; 108:403-411. [PMID: 36535257 PMCID: PMC9896317 DOI: 10.4269/ajtmh.22-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022] Open
Abstract
Quality is one of the essential components of medicines and needs to be ensured to preserve the population's health. This can be achieved through post-marketing quality control of medicines and is one of the most important duties of national regulatory authorities. In collaboration with the Cameroonian National Drug Quality Control and Valuation Laboratory, the decision was made to initiate a prevalence study to assess the quality of antiinfective medicines in Cameroon. A total of 150 samples of ciprofloxacin tablets and 142 samples of metronidazole tablets were collected from 76 licensed pharmacies and 75 informal vendors in three cities in Cameroon using a random strategy wherever possible and a mystery shopper approach. Three tests were carried out on each of the samples. Visual inspection allowed to find two falsified samples (0.7%) due to lack of information about the manufacturing company, and five more samples (1.7%) were deemed to be substandard due to flaws in the product. An additional 13 samples (4.5%) failed disintegration testing, and six (2.1%) others failed high-performance liquid chromatography assay testing due to insufficient active pharmaceutical ingredient (API) content. All samples were found to contain some API. A prevalence of 7.9% substandard or falsified (SF) medicines was found. Moreover, the prevalence of outlets selling SF medicines was greater in the informal sector (26.7%) than in the formal sector (2.6%). Although the prevalence of SF medicines found was low, efforts need to be made by national regulatory authorities to monitor the pharmaceutical market more closely.
Collapse
Affiliation(s)
- Christelle Ange Waffo Tchounga
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Pierre-Yves Sacré
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Patient Ciza Hamuli
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
- Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Rose Ngono Mballa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratoire National de Contrôle des Médicaments et Expertise, Yaoundé, Cameroon
| | - Charlotte De Bleye
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Eric Ziemons
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Philippe Hubert
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| | - Roland Marini Djang’eing’a
- Laboratory of Pharmaceutical Analytical Chemistry, Department of Pharmacy, University of Liege, CIRM, Vibra-Santé Hub, Liège, Belgium
| |
Collapse
|
14
|
Miyano S, Htoon TT, Nozaki I, Pe EH, Tin HH. Public knowledge, practices, and awareness of antibiotics and antibiotic resistance in Myanmar: The first national mobile phone panel survey. PLoS One 2022; 17:e0273380. [PMID: 35980986 PMCID: PMC9387831 DOI: 10.1371/journal.pone.0273380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/07/2022] [Indexed: 11/19/2022] Open
Abstract
In 2017, the Myanmar National Action Plan for Containment of Antimicrobial Resistance (AMR) (2017-2022) was endorsed by the Ministry of Health and Sports, Myanmar; one of its objectives was to increase public awareness of AMR to accelerate appropriate antibiotic use. This survey aimed to assess the public knowledge, practices and awareness concerning antibiotics and AMR awareness among adults in Myanmar. We conducted a nationwide cross-sectional mobile phone panel survey in January and February 2020. Participants were randomly selected from the mobile phone panel in each of three groups stratified by gender, age group, and residential area urbanity; they were interviewed using a structured questionnaire. Collected data were weighted based on the population of each stratum from the latest national census and analyzed using descriptive and inferential statistics. Two thousand and forty-five adults from 12 regions and states participated in this survey. Overall, 89.5% of participants had heard about antibiotics; however, only 0.9% provided correct answers to all five questions about antibiotics, whereas 9.7% provided all incorrect answers. More than half of participants (58.5%) purchased antibiotics without a prescription, mainly from medical stores or pharmacies (87.9%); this was more frequent in age group (18-29 years) and those in rural areas (p = 0.004 and p < 0.001, respectively). Only 56.3% were aware of antibiotic resistance and received their information from medical professionals (46.3%), family members or friends (38.9%), or the media (26.1%). Less than half (42.4%) knew that antibiotics were used in farm animals. Most did not know that using antibiotics in farm animals could develop resistance (73.2%) and is banned for the purposes of growth stimulation (64.1%). This survey identifies considerable gaps in the knowledge, practices, and awareness about antibiotics among the general population in Myanmar. Continuous public education and awareness campaigns must be urgently conducted to fulfill these gaps, which would aid in promoting antibiotic stewardship, leading to combating AMR in Myanmar.
Collapse
Affiliation(s)
- Shinsuke Miyano
- Advisor for Infectious Disease Control and Laboratory Services, Japan International Cooperation Agency (JICA), Yangon, Myanmar
- Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Thi Thi Htoon
- Department of Medical Services, National Health Laboratory (NHL) / National AMR Coordinating Center (NCC), Ministry of Health, Yangon, Myanmar
| | - Ikuma Nozaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Eh Htoo Pe
- Department of Medical Services, National Health Laboratory (NHL) / National AMR Coordinating Center (NCC), Ministry of Health, Yangon, Myanmar
| | - Htay Htay Tin
- University of Medical Technology, Yangon, Ministry of Health, Yangon, Myanmar
| |
Collapse
|
15
|
Algorithm and hyperparameter optimizations for hetero-device classification by near-infrared spectra of falsified and substandard amoxicillin capsules. ANAL SCI 2022; 38:1261-1268. [PMID: 35939234 DOI: 10.1007/s44211-022-00142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/02/2022] [Indexed: 11/01/2022]
Abstract
In this work, we optimized classification algorithms and the hyperparameters for screening falsified and substandard amoxicillin capsules. The distribution of low-quality medical products is a serious problem, especially in low- and middle-income countries. Near-infrared (NIR) spectroscopy has been proposed as the first choice for a screening device. However, preparation of the reference library for the classification training is a highly difficult process. We herein propose a hetero-device classification between training and test devices. In this proposal, Fourier-transform NIR spectrometer and portable wavelength dispersive NIR spectrometer were used as training and test devices, respectively. As the classifier candidates, we examined 13 algorithms and selected 8. We then optimized the hyperparameters for these classifiers by the grid search and cross validation methods. In the final analysis, few classifiers were found to give acceptable prediction results by the hetero-device classification. When using these methods, it is crucial to examine the results by the classification probability, due to the trade-off between sensitivity and specificity. Finally, we suggest that k-nearest neighbors, extra trees, and gradient boosting classifiers are the optimal algorithms with high classification probability for the substandard and falsified amoxicillin capsules.
Collapse
|
16
|
Hauk C, Boss M, Gabel J, Schäfermann S, Lensch HPA, Heide L. An open-source smartphone app for the quantitative evaluation of thin-layer chromatographic analyses in medicine quality screening. Sci Rep 2022; 12:13433. [PMID: 35927306 PMCID: PMC9352711 DOI: 10.1038/s41598-022-17527-y] [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: 03/22/2022] [Accepted: 07/26/2022] [Indexed: 11/09/2022] Open
Abstract
Substandard and falsified medicines present a serious threat to public health. Simple, low-cost screening tools are important in the identification of such products in low- and middle-income countries. In the present study, a smartphone-based imaging software was developed for the quantification of thin-layer chromatographic (TLC) analyses. A performance evaluation of this tool in the TLC analysis of 14 active pharmaceutical ingredients according to the procedures of the Global Pharma Health Fund (GPHF) Minilab was carried out, following international guidelines and assessing accuracy, repeatability, intermediate precision, specificity, linearity, range and robustness of the method. Relative standard deviations of 2.79% and 4.46% between individual measurements were observed in the assessments of repeatability and intermediate precision, respectively. Small deliberate variations of the conditions hardly affected the results. A locally producible wooden box was designed which ensures TLC photography under standardized conditions and shielding from ambient light. Photography and image analysis were carried out with a low-cost Android-based smartphone. The app allows to share TLC photos and quantification results using messaging apps, e-mail, cable or Bluetooth connections, or to upload them to a cloud. The app is available free of charge as General Public License (GPL) open-source software, and interested individuals or organizations are welcome to use and/or to further improve this software.
Collapse
Affiliation(s)
- Cathrin Hauk
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Mark Boss
- Computer Graphics, Department of Computer Science, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Julia Gabel
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Simon Schäfermann
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Hendrik P A Lensch
- Computer Graphics, Department of Computer Science, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Lutz Heide
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany.
| |
Collapse
|
17
|
Surveillance for substandard and falsified medicines by local faith-based organizations in 13 low- and middle-income countries using the GPHF Minilab. Sci Rep 2022; 12:13095. [PMID: 35908047 PMCID: PMC9338985 DOI: 10.1038/s41598-022-17123-0] [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: 03/14/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
This study evaluates the use of the Global Pharma Health Fund (GPHF) Minilab for medicine quality screening by 16 faith-based drug supply organizations located in 13 low- and middle-income countries. The study period included the year before the COVID-19 pandemic (2019) and the first year of the pandemic (2020). In total 1,919 medicine samples were screened using the GPHF Minilab, and samples showing serious quality deficiencies were subjected to compendial analysis in fully equipped laboratories. Thirty-four (1.8%) of the samples were found not to contain the declared active pharmaceutical ingredient (API), or less than 50% of the declared API, or undeclared APIs, and probably represented falsified products. Fifty-four (2.8%) of the samples were reported as substandard, although the true number of substandard medicines may have been higher due to the limited sensitivity of the GPHF Minilab. The number of probably falsified products increased during the COVID-19 pandemic, especially due to falsified preparations of chloroquine; chloroquine had been incorrectly advocated as treatment for COVID-19. The reports from this project resulted in four international WHO Medical Product Alerts and several national alerts. Within this project, the costs for GPHF Minilab analysis resulted as 25.85 € per sample. Medicine quality screening with the GPHF Minilab is a cost-effective way to contribute to the global surveillance for substandard and falsified medical products.
Collapse
|
18
|
Dohou AM, Yémoa AL, Guidan DBA, Ahouandjinou SHS, Amoussa A, Dossou FM, Marini Djang’eing’a R, Dalleur O. Assessment of the Quality of Injectable Antibiotics in Benin. Am J Trop Med Hyg 2022; 107:24-31. [PMID: 35895356 PMCID: PMC9294693 DOI: 10.4269/ajtmh.21-0844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/06/2022] [Indexed: 09/02/2024] Open
Abstract
Substandard and falsified medicines are an enormous threat to global health. Poor quality antibiotic preparations contribute to the development of antimicrobial resistance. In surgery, where the occurrence of healthcare-associated infections is high, healthcare teams need to rely on the quality of antibiotic prophylaxis to prevent infections. We assessed the quality of antibiotics used for surgical infection prophylaxis in Benin. Thirty-three samples were collected from six hospitals located in various departments in Benin. The antibiotics (powders for injection: amoxicillin + clavulanic acid, ampicillin, ceftriaxone; solutions for injection: ciprofloxacin, gentamicin, metronidazole) were assessed using visual inspection, pharmacotechnical tests (including uniformity of mass, pH measure, sterility test, and active pharmaceutical ingredient identification), and assay tests (including a simple analytical method thin layer chromatography) and complex analytical techniques (ultraviolet-visible spectrophotometry, high-performance liquid chromatography-diode-array detection, conductometry). Because the material needed for the methods recommended by the pharmacopeias to assess the dosage of gentamicin was not available, we developed and validated a conductometry method. Results showed that 97% (n = 32) of the samples passed visual inspection; 100% (n = 33) of the samples passed the pharmacotechnical tests, identification of active ingredients, and sterility test; 88% (n = 29) passed the test for percentage of active pharmaceutical ingredients. Overall, 15% of the samples did not pass the quality test (3% on visual inspection and 12% for excess active ingredients). Although most of the samples passed the quality tests, it appears important to perform routine quality control for intravenous medicines.
Collapse
Affiliation(s)
- Angèle Modupè Dohou
- Louvain Drug Research Institute, Clinical Pharmacy, Université Catholique de Louvain (UCLouvain), Belgium
- Laboratoire de Chimie Analytique et Analyse des Médicaments, Université d’Abomey Calavi, Bénin
| | - Achille Loconon Yémoa
- Laboratoire de Chimie Analytique et Analyse des Médicaments, Université d’Abomey Calavi, Bénin
| | | | | | - Ahmed Amoussa
- Laboratoire de Chimie Analytique et Analyse des Médicaments, Université d’Abomey Calavi, Bénin
| | - Francis Moïse Dossou
- Service de Chirurgie Générale, Centre Hospitalo-Universitaire Départemental Ouémé-Plateau, Bénin
| | - Roland Marini Djang’eing’a
- Department of Pharmacy, CIRM, Laboratory of Analytical Pharmaceutical Chemistry, University of Liege, Belgium
| | - Olivia Dalleur
- Louvain Drug Research Institute, Clinical Pharmacy, Université Catholique de Louvain (UCLouvain), Belgium
- Pharmacy Department, Cliniques Universitaires Saint-Luc, UCLouvain, Belgium
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
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.
Collapse
|
21
|
Mureyi D, Gwatidzo SD, Matyanga CMJ. Consumers’ access to information about medicine prices and availability as an enabler of last mile medicine access: A scoping review. THE JOURNAL OF MEDICINE ACCESS 2022; 6:27550834221098598. [PMID: 36204520 PMCID: PMC9413504 DOI: 10.1177/27550834221098598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
Information about where medicines are in stock and how much they cost facilitates
consumers’ timely access to affordable medicines by enabling price comparisons
and the identification of stockists. Our aims were to: (1) Review how consumer
access to price and availability information is engaged within the Medicine
Access discourse and (2) identify factors associated with the existence of
interventions that provide consumers with medicine availability and price
information. We conducted two scoping reviews. We reviewed 26 medicine access
and pharmaceutical system strengthening frameworks to assess how they
conceptualise information access. We then reviewed four interventions that
provide consumers with availability and price information to identify the
factors associated with these interventions’ existence. We found that in the
medical access discourse, information is mainly cast as helpful to entities that
ensure medicine access for populations. Information as an enabler of medicine
procurement for consumers/households is less emphasised. We then identified the
following eight factors that facilitate consumer access to reliable medicine
price and availability information: the recognition of a medicine access problem
that can be mitigated by consumer access to information; cross-sectoral
collaboration; the willingness of medicine sellers to disclose their inventory
information; having information quality control measures; appropriate incentives
for intervention adoption; enabling legal environments; systems of pooling
information; and access to digital information technology infrastructure. We
recommend that more theoretical and implementation attention ought to be
directed at how medicine price and medicine availability information can empower
individual consumers to make sound purchasing decisions.
Collapse
Affiliation(s)
- Dudzai Mureyi
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Celia MJ Matyanga
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| |
Collapse
|
22
|
Hoffman RM, Chibwana F, Kahn D, Banda BA, Phiri L, Chimombo M, Kussen C, Sigauke H, Moses A, van Oosterhout JJ, Phiri S, Currier JW, Currier JS, Moucheraud C. High Rates of Uncontrolled Blood Pressure in Malawian Adults Living with HIV and Hypertension. Glob Heart 2021; 16:81. [PMID: 34909372 PMCID: PMC8663744 DOI: 10.5334/gh.1081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/29/2021] [Indexed: 01/15/2023] Open
Abstract
Background Hypertension is among the most commonly diagnosed non-communicable diseases in Africa, and studies have demonstrated a high prevalence of hypertension among individuals with HIV. Despite high prevalence, there has been limited attention on the clinical outcomes of hypertension treatment in this population. Objective We sought to characterize rates of and factors associated with blood pressure control over one year among individuals on antiretroviral therapy (ART) and antihypertensive medications. Methods We performed a prospective observational cohort study at an HIV clinic in Malawi. We defined uncontrolled hypertension as a systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg at two or more follow-up visits during the year, while controlled hypertension was defined as <140 mm Hg systolic and <90 mm Hg diastolic at all visits, or at all but one visit. We calculated an antihypertensive non-adherence score based on self-report of missed doses at each visit (higher score = worse adherence) and used rank sum and chi-square tests to compare sociodemographic and clinical factors (including adherence) associated with blood pressure control over the year. Results At study entry, 158 participants (23.5%) were on antihypertensive medication; participants had a median age of 51.0 years, were 66.5% female, and had a median of 6.9 years on ART. 19.0% (n = 30) achieved blood pressure control over the year of follow-up. Self-reported non-adherence to hypertension medications was the only factor significantly associated with uncontrolled blood pressure. The average non-adherence score for those with controlled blood pressure was 0.22, and for those with uncontrolled blood pressure was 0.61 (p = 0.009). Conclusions Adults living with HIV and hypertension in our cohort had low rates of blood pressure control over one year associated with self-reported non-adherence to antihypertensive medications. Given the high prevalence and incidence of hypertension, interventions to improve blood pressure control are needed to prevent associated long-term cardio- and cerebrovascular morbidity and mortality.
Collapse
Affiliation(s)
- Risa M. Hoffman
- Department of Medicine and Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | | | - Daniel Kahn
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | | | | | | | | | | | | | | | | | - Jesse W. Currier
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | - Judith S. Currier
- Department of Medicine and Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | - Corrina Moucheraud
- Department of Health Policy and Management, Fielding School of Public Health at the University of California, Los Angeles, California, US
| |
Collapse
|
23
|
Hauk C, Hagen N, Heide L. Identification of Substandard and Falsified Medicines: Influence of Different Tolerance Limits and Use of Authenticity Inquiries. Am J Trop Med Hyg 2021; 104:1936-1945. [PMID: 33788775 PMCID: PMC8103440 DOI: 10.4269/ajtmh.20-1612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/05/2021] [Indexed: 11/21/2022] Open
Abstract
Substandard and falsified medicines have severe public health and socioeconomic effects, especially in low- and middle-income countries. The WHO has emphasized the need for reliable estimates of the prevalence of such medicines to efficiently respond to this problem. In the present study, we used 601 medicine samples collected in Cameroon, the DR Congo, and Malawi to assess the rates of substandard and falsified medicines based on different criteria. Based on the specifications of the U.S. Pharmacopoeia for the amount of the active pharmaceutical ingredients, the rate of out-of-specification medicines was 9.3%. By contrast, this rate ranged from 3.3% up to 35.0% if the tolerance limits of other pharmacopoeias or recently published medicine quality studies were used. This shows an urgent need for harmonization. Principal methods to assess the rate of falsified medicines are packaging analysis, chemical analysis, and authenticity inquiries. In the present study, we carried out an authenticity inquiry for the aforementioned medicine samples, contacting 126 manufacturers and 42 distributors. Response rates were higher for samples stated to be manufactured in Asia (52.4%) or Europe (53.8%) than for samples manufactured in Africa (27.4%; P < 0.001). One sample had been identified as falsified by packaging analysis by the local researchers and two additional ones by chemical analysis. Notably, seven additional falsified samples were identified by the authenticity inquiries. The total rate of falsified medicines resulted as 1.7%. Considerations are discussed for assessing the rates of "substandard" and "falsified" medicines in future medicine quality studies.
Collapse
Affiliation(s)
| | | | - Lutz Heide
- Address correspondence to Lutz Heide, Pharmaceutical Institute, Eberhard Karls University Tuebingen, Auf der Morgenstelle 8, Tuebingen 72076, Germany. E-mail:
| |
Collapse
|
24
|
Sakuda M, Yoshida N, Koide T, Keila T, Kimura K, Tsuboi H. Clarification of the internal structure and factors of poor dissolution of substandard roxithromycin tablets by near-infrared chemical imaging. Int J Pharm 2021; 596:120232. [PMID: 33484929 PMCID: PMC7910273 DOI: 10.1016/j.ijpharm.2021.120232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/18/2022]
Abstract
The spread of substandard and falsified medicines has become a global problem, especially in low- and middle-income countries (LMICs). Previously, we found that some tablets containing the same active ingredient had large differences in their dissolution even though their contents were comparable. In this study, we investigated the poor dissolution of roxithromycin tablets using near-infrared chemical imaging (NIR-CI) to visualize the internal tablet structure. Roxithromycin tablets collected in LMICs and the pioneer product Rulid® as a reference were cut to a flat surface for analysis. NIR spectral data were normalized, and a principal component analysis was performed to create a tablet internal structure image. For Rulid®, the differences between the spectra with high and low scores were small, and well-defined aggregation of ingredients was not observed. However, large differences in the scores were found for roxithromycin tablets manufactured in some LMICs, and non-uniformity of ingredient distribution and aggregation were observed. Additionally, some pharmaceutical excipients, such as starch or magnesium stearate, were found in certain aggregates by comparing NIR spectra. The NIR-CI results showed some excipients existed as large aggregates, which indicated that the ingredients were not evenly mixed in the roxithromycin tablet, and this contributed to its poor dissolution.
Collapse
Affiliation(s)
- Mirai Sakuda
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa 920-1192, Japan
| | - Naoko Yoshida
- AI Hospital/Macro Signal Dynamics Research and Development Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa 920-1192, Japan.
| | - Tatsuo Koide
- Division of Drugs, National Institute of Health Sciences, Kawasaki 210-9501, Japan
| | - Tep Keila
- National Health Product Quality Control Center, Ministry of Health, Phnom Penh 12110, Cambodia
| | - Kazuko Kimura
- Medi-Quality Security Institute, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-1192, Japan
| | - Hirohito Tsuboi
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa 920-1192, Japan
| |
Collapse
|
25
|
Hagen N, Bizimana T, Kayumba PC, Khuluza F, Heide L. Stability of Oxytocin Preparations in Malawi and Rwanda: Stabilizing Effect of Chlorobutanol. Am J Trop Med Hyg 2020; 103:2129-2141. [PMID: 32748770 PMCID: PMC7646793 DOI: 10.4269/ajtmh.20-0255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Oxytocin is used for the prevention and treatment of postpartum hemorrhage, the leading cause of maternal mortality in low- and middle-income countries. Because of the high instability of oxytocin, most products are labeled for storage at 2–8°C. Some other products are on the market which are labeled for non-refrigerated storage, but independent evaluations of their stability hardly exist. In the present study, seven brands (nine batches) of oxytocin were purchased from wholesalers and medical stores in Malawi and Rwanda and investigated by accelerated stability testing according to the ICH/WHO guidelines. Two oxytocin brands approved by a stringent regulatory authority (SRA) or by the WHO Prequalification of Medicines program and purchased in Europe were used as comparison. All investigated brands which were either produced in countries with SRAs, or were WHO-prequalified products, were labeled for storage at 2–8°C, and all of them passed stability testing with very good results. Even exposure to 25°C or 30°C for several months hardly affected their oxytocin content. However, two other investigated brands were labeled for non-refrigerated storage, and both of them had been produced in countries without SRAs. These two preparations showed not higher but lower stability than the brands labeled for storage at 2–8°C, and, for both of them, noncompliance with pharmacopoeial specifications was found after accelerated stability testing. At 40°C, and in forced degradation studies at 80°C, chlorobutanol showed a remarkable stabilizing effect on oxytocin, which may deserve further investigation. The results of the present study support the policy “Buy Quality Oxytocin, Keep It Cool.”
Collapse
Affiliation(s)
- Nhomsai Hagen
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Thomas Bizimana
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Pierre Claver Kayumba
- East African Community Regional Centre of Excellence for Vaccines, Immunizations and Health Supply Chain Management (EAC RCE-VIHSCM), University of Rwanda, Kigali, Rwanda
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lutz Heide
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| |
Collapse
|
26
|
Nebot Giralt A, Bourasseau A, White G, Pouget C, Tabernero P, Van Assche K, Ravinetto R. Quality assurance systems of pharmaceutical distributors in low-income and middle-income countries: weaknesses and ways forward. BMJ Glob Health 2020; 5:e003147. [PMID: 33037061 PMCID: PMC7549486 DOI: 10.1136/bmjgh-2020-003147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Access to quality-assured medicines is an essential prerequisite for universal health coverage, and pharmaceutical distributors play an important role to assure the quality of medicines along the supply chain. METHODS We retrospectively assessed the compliance with WHO quality standards, that is, the Model Quality Assurance System for Procurement Agencies (MQAS) or the good distribution practices (GDP), of a convenience sample of 75 public, private-for-profit and non-for-profit distributors, audited by QUAMED in 14 low-income and middle-income countries (LMICs) between 2017 and 2019. We calculated the compliance per quality assurance activity, and we defined the percentage of compliant distributors, that is, the percentage (%) of distributors with MQAS or GDP levels of >2 for each activity. RESULTS The distributors in our sample were mainly private for-profit (66/75). Only one MQAS-audited distributor out of 11 was found compliant with all MQAS-activities, while none out of 64 GDP-assessed distributors were found compliant with all GDP activities. The GDP-assessed distributors were generally less compliant with WHO standards than MQAS-audited distributors. Common weaknesses and strengths were observed. The activities with lowest compliance were quality control, and physical storage conditions, while those with highest compliance were warehouse organisation and stock control. CONCLUSIONS The quality systems of pharmaceutical distributors in LMICs remain weak. For preventing harm caused by poor-quality medicines, a comprehensive and stringent regulatory oversight should be urgently implemented; the WHO MQAS-standards and GDP-standards should be incorporated in national regulations; and reliable information on the quality systems of distributors (and manufacturers from which they buy) should be publicly available.
Collapse
Affiliation(s)
| | | | - Gareth White
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Patricia Tabernero
- Public Health Unit, Faculty of Medicine, University of Alcalá, Alcalà de Henares, Spain
| | - Kerlijn Van Assche
- Medicine Quality Research Group, Infectious Diseases Data Observatory, Oxford, UK
- Centre for Tropical Medicine and Global Health, Mahidol Oxford Tropical Health Network, University of Oxford, Oxford, UK
| | - Raffaella Ravinetto
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| |
Collapse
|
27
|
Hagen N, Bizimana T, Kayumba PC, Khuluza F, Heide L. Stability of misoprostol tablets collected in Malawi and Rwanda: Importance of intact primary packaging. PLoS One 2020; 15:e0238628. [PMID: 32877459 PMCID: PMC7467217 DOI: 10.1371/journal.pone.0238628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022] Open
Abstract
Misoprostol is listed in the WHO essential medicines list and can be used for induction of labour, for prevention and treatment of post-partum haemorrhage, and for abortions. The compound is unstable, and substandard misoprostol preparations have been detected in low- and middle-income countries. We now investigated the stability of misoprostol tablets according to the international guidelines for stability testing of pharmaceutical products. Three brands (four batches) of misoprostol tablets were collected in Malawi and Rwanda: the originator product, a WHO-prequalified product, and a generic product without WHO prequalification. A further batch of the originator product was collected in Germany. To investigate the effect of damage to the primary packaging, additional blister strips of one sample were intentionally damaged with a needle and investigated in parallel. Samples were placed in stability chambers for six months at 40°C/75% relative humidity (RH) and at 25°C/60% RH. After 0, 1, 2, 3 and 6 months, misoprostol content was determined according to the International Pharmacopeia. At 40°C/75% RH, all samples showed a decline of misoprostol content, but four of the batches still remained within the pharmacopeial specifications, while one of the two batches of the generic product without WHO-prequalification showed a final content of 86.2% which is out of specifications. Damage to the primary packaging greatly decreased stability, resulting in a final content of only 48.2% of the declared misoprostol amount. At 25°C/60% RH all samples remained in specifications for six months, even the sample with the damaged blister. Dissolution of misoprostol remained in specifications of the pharmacopoeia for six months for all batches, except for the sample with damaged blisters stored at 40°C/75% RH. This study confirms that the stability of misoprostol tablets must be ensured by intact, good-quality primary packaging. Careful supplier qualification is required in the procurement process.
Collapse
Affiliation(s)
- Nhomsai Hagen
- Pharmaceutical Institute, Eberhard Karls University Tubingen, Tubingen, Germany
| | - Thomas Bizimana
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - P. Claver Kayumba
- East African Community Regional Centre of Excellence for Vaccines, Immunizations and Health Supply Chain Management (EAC RCE-VIHSCM), University of Rwanda, Kigali, Rwanda
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lutz Heide
- Pharmaceutical Institute, Eberhard Karls University Tubingen, Tubingen, Germany
- * E-mail:
| |
Collapse
|
28
|
Gnegel G, Hauk C, Neci R, Mutombo G, Nyaah F, Wistuba D, Häfele-Abah C, Heide L. Identification of Falsified Chloroquine Tablets in Africa at the Time of the COVID-19 Pandemic. Am J Trop Med Hyg 2020; 103:73-76. [PMID: 32400349 PMCID: PMC7263564 DOI: 10.4269/ajtmh.20-0363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Reports that chloroquine and hydroxychloroquine may be effective against COVID-19 have received worldwide attention, increasing the risk of the introduction of falsified versions of these medicines. Five different types of falsified chloroquine tablets were discovered between March 31, 2020 and April 4, 2020, in Cameroon and the Democratic Republic of Congo by locally conducted thin layer chromatographic analysis. Subsequent investigation by liquid chromatography and mass spectrometry in Germany proved the absence of detectable amounts of chloroquine and the presence of undeclared active pharmaceutical ingredients, that is, paracetamol and metronidazole, in four of the samples. The fifth sample contained chloroquine, but only 22% of the declared amount. Such products represent a serious risk to patients. Their occurrence exemplifies that once medicines or vaccines against COVID-19 may be developed, falsified products will enter the market immediately, especially in low- and middle-income countries (LMICs). Timely preparations for the detection of such products are required, including the establishment of appropriate screening technologies in LMICs.
Collapse
Affiliation(s)
- Gesa Gnegel
- German Institute for Medical Mission (Difaem), Tuebingen, Germany.,Pharmaceutical Institute, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Cathrin Hauk
- Pharmaceutical Institute, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Richard Neci
- Le Dépôt Central Médico-Pharmaceutique de La 8e CEPAC (DCMP), Bukavu, Democratic Republic of Congo.,Ecumenical Pharmaceutical Network, Nairobi, Kenya
| | - Georges Mutombo
- Le Dépôt Central Médico-Pharmaceutique de La 8e CEPAC (DCMP), Bukavu, Democratic Republic of Congo
| | - Fidelis Nyaah
- Presbyterian Church in Cameroon (PCC), Central Pharmacy, Limbe, Cameroon
| | - Dorothee Wistuba
- Institute of Organic Chemistry, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | | | - Lutz Heide
- Pharmaceutical Institute, Eberhard Karls University Tuebingen, Tuebingen, Germany
| |
Collapse
|