Quality Testing of Artemisinin-Based Antimalarial Drugs in Myanmar. 2017

Suqin Guo, and Myat Phone Kyaw, and Lishan He, and Myo Min, and Xiangxue Ning, and Wei Zhang, and Baomin Wang, and Liwang Cui
College of Agronomy and Biotechnology, China Agricultural University, Beijing, China.

Artemisinin-based combination therapies are the frontline treatment of Plasmodium falciparum malaria. The circulation of falsified and substandard artemisinin-based antimalarials in Southeast Asia has been a major predicament for the malaria elimination campaign. To provide an update of this situation, we purchased 153 artemisinin-containing antimalarials, as convenience samples, in private drug stores from different regions of Myanmar. The quality of these drugs in terms of their artemisinin derivative content was tested using specific dipsticks for these artemisinin derivatives, as point-of-care devices. A subset of these samples was further tested by high-performance liquid chromatography (HPLC). This survey identified that > 35% of the collected drugs were oral artesunate and artemether monotherapies. When tested with the dipsticks, all but one sample passed the assays, indicating that the detected artemisinin derivative content corresponded approximately to the labeled contents. However, one artesunate injection sample was found to contain no active ingredient at all by the dipstick assay and subsequent HPLC analysis. The continued circulation of oral monotherapies and the description, for the first time, of falsified parenteral artesunate provides a worrisome picture of the antimalarial drug quality in Myanmar during the malaria elimination phase, a situation that deserves more oversight from regulatory authorities.

UI MeSH Term Description Entries
D002052 Myanmar A republic of southeast Asia, northwest of Thailand, long familiar as Burma. Its capital is Yangon, formerly Rangoon. Inhabited by people of Mongolian stock and probably of Tibetan origin, by the 3d century A.D. it was settled by Hindus. The modern Burmese state was founded in the 18th century but was in conflict with the British during the 19th century. Made a crown colony of Great Britain in 1937, it was granted independence in 1947. In 1989 it became Myanmar. The name comes from myanma, meaning the strong, as applied to the Burmese people themselves. (From Webster's New Geographical Dictionary, 1988, p192 & Room, Brewer's Dictionary of Names, 1992, p367) Burma,Myanma
D004359 Drug Therapy, Combination Therapy with two or more separate preparations given for a combined effect. Combination Chemotherapy,Polychemotherapy,Chemotherapy, Combination,Combination Drug Therapy,Drug Polytherapy,Therapy, Combination Drug,Chemotherapies, Combination,Combination Chemotherapies,Combination Drug Therapies,Drug Polytherapies,Drug Therapies, Combination,Polychemotherapies,Polytherapies, Drug,Polytherapy, Drug,Therapies, Combination Drug
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000962 Antimalarials Agents used in the treatment of malaria. They are usually classified on the basis of their action against plasmodia at different stages in their life cycle in the human. (From AMA, Drug Evaluations Annual, 1992, p1585) Anti-Malarial,Antimalarial,Antimalarial Agent,Antimalarial Drug,Anti-Malarials,Antimalarial Agents,Antimalarial Drugs,Agent, Antimalarial,Agents, Antimalarial,Anti Malarial,Anti Malarials,Drug, Antimalarial,Drugs, Antimalarial
D058110 Counterfeit Drugs Fake medicine that may be contaminated or contain the wrong or no active ingredient, or the correct active ingredient at the wrong dose. Counterfeit drugs are illegal and may be harmful to health. Counterfeit Drug,Counterfeit Medicine,Fake Drug,Falsified Drug,Falsified Medicine,Counterfeit Medicines,Fake Drugs,Falsified Drugs,Falsified Medicines,Drug, Counterfeit,Drug, Fake,Drug, Falsified,Drugs, Counterfeit,Drugs, Fake,Drugs, Falsified,Medicine, Counterfeit,Medicine, Falsified,Medicines, Counterfeit,Medicines, Falsified
D037621 Artemisinins A group of SESQUITERPENES and their analogs that contain a peroxide group (PEROXIDES) within an oxepin ring (OXEPINS).

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