Antibiotics found in street markets in Haiti have important quality problems, and sometimes these products contain other ingredients than labelled

Overview

In 2019, we visited 28 street markets in Port-au-Prince (Haiti) and bought 258 packs containing antibiotics. Once in the laboratory, we analyzed the content of the pills and capsules included in these packs by using a Raman handheld spectrometer (NanoRAM of BWTEK, Model: BWS456-785). Only for three out of 11 antimicrobials (Amoxicillin, Metronidazole, and Cotrimoxazole) had a good or acceptable quality for more than 95% of their tablets/capsules. But it should be highlighted that for six antimicrobials (Tetracycline, Erythromycin, Cloxacillin, Azithromycin, Clarithromycin, and the combination Amoxicillin + Clavulanic Acid) none of their tablets/capsules showed a sufficient quality as compared with the authentic medicine. This findings indicate that the products sold in the markets did not contain the labelled drug and/or contained a degraded drug. So, patients taking them will not be cured in many cases and, what is worst, could be taking other medicines not appropriate for their condition. Finally, this situation could contribute to the growing threat of resistance to antibiotics.

Summary

In many street markets, medicines are freely sold. This pilot study can help other researchers in many countries to easily highlight this problem in their markets, thus contributing to design campaigns to improve this situation.

Author Comments

Albert Figueras, MD, PhD
Albert Figueras, MD, PhD
Universitat Autònoma de Barcelona
Assoc. Professor
Pharmacoepidemiology
Barcelona, Barcelona | Spain
Counterfeit and substandard medicines are quite common in many countries. Unfortunately, it is a widespread problem, and it is difficult to fight against it. This quite simple method could be useful because this can allow identifying the importance of the problem in countries with informal street markets.Albert Figueras, MD, PhD

Substandard Quality of the Antimicrobials Sold in the Street Markets in Haiti

Antibiotics

Antibiotics 2020, 9(7), 407

This pilot study was conducted to analyze the quality of the antimicrobials sold in the street markets in Port-au-Prince, Haiti. A total of 258 packs containing antimicrobials were bought in 28 street markets in Port-au-Prince (Haiti). Tablets and contents of capsules included in 196 packs were analyzed using a Raman handheld spectrometer (NanoRAM of BWTEK, Model: BWS456-785) during the first quarter of 2019. Three out of 11 antimicrobials (Amoxicillin, Metronidazole, and Cotrimoxazole) had a high spectral match with an HQI ≥ 90 to the respective authentic medicine for more than 95% of their tablets/capsules. For six antimicrobials (Tetracycline, Erythromycin, Cloxacillin, Azithromycin, Clarithromycin, and the combination Amoxicillin + Clavulanic Acid) none of their tablets/capsules showed a sufficient spectral match with the authentic medicine. This finding indicates that these products sold in the markets did not contain the labeled drug and/or contained a degraded drug. In addition to the fact that prescription antimicrobials can be purchased in street markets, the present field study found that for most of them (including “Watch” antimicrobials according to the AWaRe classification) were substandard, which contributes to the present antimicrobials resistance epidemic.
July 2020
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