The current generation of antibiotics is finding it harder
and harder to cure bacterial illnesses in underdeveloped nations like Tanzania.
Antibiotic resistance is facilitated by the widespread availability of
substandard drugs, which puts the treatment of bacterial infections at risk.
Antibiotics degrade more quickly when they are improperly stored or exposed to
extreme tropical weather. Children under the age of five are estimated to
suffer significant morbidity and mortality from infectious diseases, especially
pneumonia and acute febrile illness when they lack access to conventional
medical care, especially antibiotics. The majority of these incidents occur in
low- and middle-income countries (LMICs).
Where antibiotic sellers are less common, where antibiotic
prescriptions are tightly enforced, or where antibiotics are more costly, there
is usually a lower consumption rate than in other settings, especially for mild
conditions that probably don’t need antimicrobial treatment. Broad-spectrum
antibiotics belonging to the Watch group of the World Health Organization's
(WHO) AWaRe classification accounted for more antibiotic sales.
In Tanzania, over 60% of antibiotic and antimicrobial
consumption is in accordance with WHO’s target and Tanzania’s Access component
of the AWaRE classification. However, there is wide variation in the amount and
types of antibiotics imported each year in the country, making it difficult to
draw conclusions and identify meaningful trends going forward with regard to
the consumption of certain classes of antibiotics.
The quality of imported medicine and methods for its
assessment plays a major role in the effectiveness of therapies and the
treatment of many infectious diseases. Poor-quality and/or falsified products
are circulating in huge amounts in many LMICs, which is one of the major
reasons why more and more resistant bacteria emerge. This conflicting finding
calls for a better understanding of issues surrounding antibiotic access and
use in LMICs because these countries simultaneously face high burdens of
antimicrobial resistance.
Consequently, a need was felt to conduct a microbiological
cross-sectional study on the quality of some antibiotics, selected from
administrative regions along the borders of Tanzania. That study was
complemented by a systematic literature search on the quality of antibiotics
available in LMICs, with special emphasis on Tanzania. The microbiological
analysis involved seventy-six antibiotics from 22 manufacturers, of which six
were from anonymous manufacturers and 29 had no manufacturing or expiration
dates. Different antibiotic samples of the same kind produced variable results.
Ambiguous antibacterial profiles were exhibited by samples of ampicillin,
chloramphenicol, cotrimoxazole, and amoxicillin as compared to their respective
positive control antibiotics. The findings from the systematic review showed
that in many cases, there were completely different active principal
ingredients (APIs) compared to the declared ones. Therefore, these findings
suggest the existence of counterfeit and/or substandard drugs in Tanzania, as
significant variances in antibacterial effects were observed among antibiotics
of the same type, which could have uncertain clinical outcomes.
The WHO describes substandard drugs as being “out-of-spec”
and “authorized drugs that fail to meet either their quality standards or
specifications, or both.” Substandard antibiotics may appear at the raw or
crude API level because the antibiotic molecule may become unstable under
specific storage circumstances or because there are too many potentially
hazardous impurities.
Several factors have been pointed out to the availability of
poor-quality antibiotics, which include weak penal sanctions, frail or absent
national drug regulatory authorities, lack of proper drug law enforcement, lack
of control of drugs for export, corruption, and conflict of interest, a dearth
of political will and cooperation from stakeholders and other enforcers, just
to mention a few.
Author (s) Details
Kennedy D. Mwambete
Department of Pharmaceutical Microbiology, Muhimbili University of Health
and Allied Sciences, Dar es Salaam, Tanzania.
Please see the book here:- https://doi.org/10.9734/bpi/rpmab/v6/1056
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