A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistance
Autor: | Christina Y. Hampton, Latsamy Vongsack, Vongsavanh Insixiengmay, Sivong Sengaloundeth, Lamphet Khounsaknalath, Leonard Nyadong, Michael D. Green, Dana M. Hostetler, Dallas C. Mildenhall, Ot Manolin, Paul N. Newton, Khamlieng Phommavong, Lamphone Syhakhang, Viengxay Vanisaveth, Facundo M. Fernández, Samlane Phompida |
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Rok vydání: | 2009 |
Předmět: |
lcsh:Arctic medicine. Tropical medicine
lcsh:RC955-962 030231 tropical medicine Drug Resistance Artesunate Drug resistance Chemistry Techniques Analytical Poor quality lcsh:Infectious and parasitic diseases Antimalarials Random Allocation 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine medicine Animals Humans lcsh:RC109-216 Treatment Failure 030212 general & internal medicine Artemisinin Traditional medicine business.industry Research medicine.disease Artemisinins Malaria 3. Good health Stratified sampling Counterfeit Cross-Sectional Studies Infectious Diseases chemistry Laos Therapeutic failure Parasitology business medicine.drug |
Zdroj: | Malaria Journal, Vol 8, Iss 1, p 172 (2009) Malaria Journal |
ISSN: | 1475-2875 |
Popis: | Background Counterfeit oral artesunate has been a major public health problem in mainland SE Asia, impeding malaria control. A countrywide stratified random survey was performed to determine the availability and quality of oral artesunate in pharmacies and outlets (shops selling medicines) in the Lao PDR (Laos). Methods In 2003, 'mystery' shoppers were asked to buy artesunate tablets from 180 outlets in 12 of the 18 Lao provinces. Outlets were selected using stratified random sampling by investigators not involved in sampling. Samples were analysed for packaging characteristics, by the Fast Red Dye test, high-performance liquid chromatography (HPLC), mass spectrometry (MS), X-ray diffractometry and pollen analysis. Results Of 180 outlets sampled, 25 (13.9%) sold oral artesunate. Outlets selling artesunate were more commonly found in the more malarious southern Laos. Of the 25 outlets, 22 (88%; 95%CI 68–97%) sold counterfeit artesunate, as defined by packaging and chemistry. No artesunate was detected in the counterfeits by any of the chemical analysis techniques and analysis of the packaging demonstrated seven different counterfeit types. There was complete agreement between the Fast Red dye test, HPLC and MS analysis. A wide variety of wrong active ingredients were found by MS. Of great concern, 4/27 (14.8%) fakes contained detectable amounts of artemisinin (0.26–115.7 mg/tablet). Conclusion This random survey confirms results from previous convenience surveys that counterfeit artesunate is a severe public health problem. The presence of artemisinin in counterfeits may encourage malaria resistance to artemisinin derivatives. With increasing accessibility of artemisinin-derivative combination therapy (ACT) in Laos, the removal of artesunate monotherapy from pharmacies may be an effective intervention. |
Databáze: | OpenAIRE |
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