Abstract
BackgroundRecently global health advocates have called for the introduction of artemisinin-containing antimalarial combination therapies to help curb the impact of drug-resistant malaria in Africa. Retail trade in artemisinin monotherapies could undermine efforts to restrict this class of medicines to more theoretically sound combination treatments.MethodsThis paper describes a systematic search for artemisinin-containing products at a random sample of licensed pharmacies in Dar-es-Salaam, Tanzania in July 2005.ResultsNineteen different artemisinin-containing oral pharmaceutical products, including one co-formulated product, one co-packaged product, and 17 monotherapies were identified. All but one of the products were legally registered and samples of each product were obtained without a prescription. Packaging and labeling of the products seldom included local language or illustrated instructions for low-literate clients. Packaging and inserts compared reasonably well with standards recommended by the national regulatory authority with some important exceptions. Dosing instructions were inconsistent, and most recommended inadequate doses based on international standards. None of the monotherapy products mentioned potential benefits of combining the treatment with another antimalarial drug.ConclusionThe findings confirm the widespread availability of artemisinin monotherapies that led the World Health Organization to call for the voluntary withdrawal of these drugs in malaria-endemic countries. As the global public health community gathers resources to deploy artemisinin-containing combination therapies in Africa, planners should be mindful that these drugs will coexist with artemisinin monotherapies in an already well-established market place. In particular, regulatory authorities should be incorporated urgently into the process of planning for rational deployment of artemisinin-containing antimalarial combination therapies.
Highlights
Global health advocates have called for the introduction of artemisinincontaining antimalarial combination therapies to help curb the impact of drug-resistant malaria in Africa
The 19 products available are listed in Table 1 below, which compares the relative prevalence of each product and its mean purchase price as well as pharmacists' perceptions of the best selling brands
A recent report from the United States (US) Institute of Medicine (IOM) describes a twofold challenge: "to facilitate widespread use of artemisinins while, at the same time, to preserve their effectiveness for as long as possible[18]." In its report, the group advances its case for a global level subsidy combined with a coordinated worldwide effort to procure and deploy artemisinin compounds exclusively in combination therapies co-formulated with other antimalarial drugs
Summary
Global health advocates have called for the introduction of artemisinincontaining antimalarial combination therapies to help curb the impact of drug-resistant malaria in Africa. Artemisinin-containing combination treatments (ACTs) are recommended to stem the rising tide of drug-resistant malaria in Africa[1]. Widespread public-sector deployment of artemisinin-containing drugs has been constrained by their relatively high cost and limited global supply, as well as some lingering concerns about safety[2,3]. In Tanzania, no fewer than 31 artemisinin-containing compounds have been registered with the Food and Drugs Authority[6]. These include a range of oral and parenteral products sold from pharmacies as prescription only medicines. This study was undertaken to identify and describe the range of oral artemisinin products currently available in one urban setting
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