Pharmacopeial quality of artemether–lumefantrine anti-malarial agents in Uganda

Malaria Journal

Research

Caroline Otike¹  Sam Nsobya²  Moses Ocan³  Loyce Nakalembe⁴  Denis Omali⁵  Allan Buzibye⁵ 

[1] Data Department, Joint Clinical Research Centre, P. O Box 10005, Lubowa, Kampala, Uganda;Department of Pathology, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda;Department of Pharmacology and Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda;Department of Pharmacology, Soroti University, P.O. Box 211, Soroti, Uganda;Pharmacokinetics Laboratory Unit, Infectious Disease Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda;

关键词: Artemether–lumefantrine;    Substandard quality;    Pharmacopoeia;    Active pharmaceutical ingredient;    Malaria;   

DOI  :  10.1186/s12936-023-04600-8

 received in 2022-08-24, accepted in 2023-05-20,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSubstandard anti-malarial agents pose a significant challenge to effective malaria control and elimination efforts especially in sub-Saharan Africa. The quality of anti-malarials in most low-and-middle income countries (LMICs) is affected by several factors including inadequate regulation and limited resources. In this study, the pharmacopeial quality of artemether–lumefantrine (AL) in low and high malaria transmission settings in Uganda was assessed.MethodsThis was a cross-sectional study conducted among randomly selected private drug outlets. The AL anti-malarials available in drug outlets were purchased using overt method. The samples were screened for quality using visual inspection, weight uniformity, content assay and dissolution tests. The assay test was done using liquid chromatography–mass spectrometry (LC–MS). The samples were considered substandard if the active pharmaceutical ingredient (API) content was outside 90–110% range of the label claim. Dissolution test was conducted following United States Pharmacopoeia (USP) method. Data was analysed using descriptive statistics and presented as means with standard deviations, frequencies, and proportions. Correlation between medicine quality and independent variables was determined using Fisher’s exact test of independence at 95% level of significance.ResultsA total of 74 AL anti-malarial samples were purchased from high (49/74; 66.2%) and low (25/74; 33.8%) malaria transmission settings. The most common batch of AL was LONART, 32.4% (24/74), with 33.8% (25/74) being ‘Green leaf’. Overall prevalence of substandard quality artemether–lumefantrine was 18.9% (14/74; 95% CI: 11.4–29.7). Substandard quality AL was significantly associated with setting (p = 0.002). A total of 10 samples (13.5%) failed artemether content assay test while, 4 samples (5.4%, 4/74) failed the lumefantrine assay test. One sample from a high malaria transmission setting failed both artemether and lumefantrine assay content test. Of the samples that failed artemether assay test, 90% had low (< 90%) artemether content. All the samples passed visual inspection and dissolution tests.ConclusionArtemether–lumefantrine agents, the recommended first-line treatment for uncomplicated malaria with APIs outside the recommended pharmacopeial content assay limit is common especially in high malaria transmission settings. There is need for continuous surveillance and monitoring of the quality of artemisinin-based anti-malarials across the country by the drug regulatory agency.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

40517_2023_256_Article_IEq12.gif

Fig. 1