Threats posed by stockpiles of expired pharmaceuticals in low- and middle-income countries: a Ugandan perspective

In some low- and middle-income countries, the national stores and public-sector health facilities contain large stocks of pharmaceuticals that are past their expiry dates. In low-income countries like Uganda, many such stockpiles are the result of donations. If not adequately monitored or regulated, expired pharmaceuticals may be repackaged and sold as counterfeits or be dumped without any thought of the potential environmental damage. The rates of pharmaceutical expiry in the supply chain need to be reduced and the disposal of expired pharmaceuticals needs to be made both timely and safe. Many low- and middle-income countries need to: (i)strengthen public systems for medicines' management, to improve inventory control and the reliability of procurement forecasts; (ii) reduce stress on central medical stores, through liberalization and reimbursement schemes; (iii) strengthen the regulation of drug donations; (iv) explore the salvage of officially expired pharmaceuticals, through re-analysis and possible shelf-life extension; (v) strengthen the enforcement of regulations on safe drug disposal; (vi) invest in an infrastructure for such disposal, perhaps based on ultra-high-temperature incinerators; and (vii) include user accountability for expired pharmaceuticals within the routine accountability regimes followed by the public health sector

Post-Marketing Stability Surveillance: Amoxicillin

Background: To ensure the successful treatment of infectious disease using antimicrobial therapy; a sufficient concentration of the stable; active drug is required at the site of infection. For the achievement of this with respect to the Beta-lactam group of antibiotics; of which amoxicillin is a member; the presence of an intact Beta-lactam ring is essential. Destruction of this sensitive ring can lead to the ingestion of an inactive drug. This can contribute to treatment failure and antibiotic resistance. Thus; the aims of this study were to determine whether the types of packaging in which amoxicillin preparations are dispensed and the temperature and humidity conditions under which they are stored by patients are adequate and appropriate to ensure drug stability.Methods: A mini-survey of pharmacies and patients was conducted in order to determine the types of packaging in which amoxicillin preparations are dispensed and the temperature and humidity conditions under which they are stored by patients. The amoxicillin preparations in the identified types of packaging were subjected to simulated conditions that represented the identified temperature and humidity stresses that occurred under patient storage conditions for a duration of 14 days. The extent of breakage of the Beta-lactam ring was then chemically determined on day 1; day 7 and day 14; using an iodometric titration method.Results: The mini-survey identified four types of packaging in which amoxicillin capsules are dispensed - plastic packets; flip-top amber bottles; flip-top amber bottles with cotton wool and flip-top transparent bottles with cotton wool. The laboratory analyses showed that only those amoxicillin capsules stored between 20 and 25 0C and protected from moisture were stable in all four identified types of packaging for 14 days. The mini-survey also indicated that 47 of the patient sample did not store their antibiotic suspensions in the refrigerator. The laboratory analyses showed that only amoxicillin suspensions stored between 2 and 8 0C for seven days showed the lowest level of degradation.Conclusion: The results of this study indicate that reconstituted amoxicillin suspensions should be stored in the temperature range 2 to 8 0C; and that the reconstitution and dispensing of a 14-day supply of amoxicillin suspensions should be discouraged; even if the drug is stored in this temperature range. For amoxicillin capsules; the results obtained in this study indicate that significant breakage of the Beta-lactam ring of amoxicillin capsules can occur in hot and humid climatic conditions if inadequate types of packaging are used and storage occurs under inappropriate conditions. The results of the study point to the importance of drug stability knowledge as a prerequisite for the dispensing of medicines; the importance of the provision of patient counselling with regard to drug storage requirements; as well as a requirement for amoxicillin capsules to be dispensed in the original manufacturers' containers in geographical areas that are hot and humid

Effects of some storage conditions on the stability of hydrocortisone sodium succinate injections

In this study; the effects of some environmental storage conditions -light; temperature and humidity on the stability of the steroidal drug; hydrocortisone sodium succinate injection were investigated. The drug samples were stored at varying conditions of light; temperature (0OC; 28OC and 60OC) and humidity; after which each sample was assayed at weekly intervals for their content of the drug using a UV -Vis spectrophotometer. From the results obtained; storage under light; at enhanced temperature and in the presence of moisture had pronounced degradative effects on the stability of hydrocortisone sodium succinate injection; calling for caution in the storage of this widely used anti-allergic and anti-inflammatory drug

A report of a mission to Malawi; 7 - 25 November; 1983

The purpose of the mission was to assess the need for spare parts and cold chain training and make recommendations on any further equipment required

A preliminary investigation into the cold-chain being operated by the Ministry of Health in the Republic of Malawi

The report summary states that the cold chain operates reasonably well and all health staff seem to be aware of the different storage needs of different vaccines; however new equipment and better monitoring of refrigeration performance and maintenance of equipment is necessary at all levels

A report of a mission to Malawi 7th - 25th November; 1983

The purpose of the visit was to asses the need for spare parts and cold chain training; investigate availability of gas as a fuel for the cold chain and make recommendations on any further equipment that is needed

Availability; provision and use of drugs: exemplary research protocol; research results and their implementation

This is the first in a five-volume series published by the Joint HSR Project. It deals with problems in availability; provision and use of essential drugs and discusses four studies on this issue; which were carried out in four different countries: Ghana; Malawi; Mauritius and Zambia. Part One contains the exemplary research protocol based on the study done in Mauritius. Parts Two to Four involve all four country studies and discuss the methodologies used; results; recommendations and their implementation respectively. The series should enable other researchers in developing their own studies on availability; provision and use of drugs

Drugs and medical supplies: manufacture; procurement; control and distribution

This document deals with the development of improved systems and procedures for procurement; inventory control and storage of medical supplies at CMS

Pharmaceutical logistics

A study of inventory control and procurement procedures at Central Medical Stores (CMS)

Malawi drug action programme: situation analysis medical stores

A study into the decentralization of the drug distribution system at the Central Medical Stores

Analyse des procedures d'approvisionnement et de gestion des stocks de medicaments essentiels par l'evaluation du controle interne au projet sante district de Pickine - Senegal

L'auteur de cette these propose apres avoir circonscrit le probleme de son etude; de situer l'importance de l'evaluation du controle interne; l'interet; les objectifs de l'etude ensuite la methodologie suivie. Il tente une analyse de la situation afin d'identifier les forces et les faiblesses majeures des sous systemes d'approvisionnement et de stockage des medicaments essentiels et les consequenses sur la vie du projet