Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa

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Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa
Gaurvika M L Nayyar, Joel G Breman, Paul N Newton, James Herrington
Lancet Infect Dis 2012; 12: 488–96
Poor-quality antimalarial drugs lead to drug resistance and inadequate treatment, which pose an urgent threat to
vulnerable populations and jeopardise progress and investments in combating malaria. Emergence of artemisinin
resistance or tolerance in Plasmodium falciparum on the Thailand–Cambodia border makes protection of the
eff ectiveness of the drug supply imperative. We reviewed published and unpublished studies reporting chemical
analyses and assessments of packaging of antimalarial drugs. Of 1437 samples of drugs in fi ve classes from seven
countries in southeast Asia, 497 (35%) failed chemical analysis, 423 (46%) of 919 failed packaging analysis, and
450 (36%) of 1260 were classifi ed as falsifi ed. In 21 surveys of drugs from six classes from 21 countries in sub-Saharan
Africa, 796 (35%) of 2297 failed chemical analysis, 28 (36%) of 77 failed packaging analysis, and 79 (20%) of 389 were
classifi ed as falsifi ed. Data were insuffi cient to identify the frequency of substandard (products resulting from poor
manufacturing) antimalarial drugs, and packaging analysis data were scarce. Concurrent interventions and a
multifaceted approach are needed to defi ne and eliminate criminal production, distribution, and poor manufacturing
of antimalarial drugs. Empowering of national medicine regulatory authorities to protect the global drug supply is
more important than ever.


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