Amoxicillin and Cotrimoxazole Antibiotics in Nairobi County Brands

Amoxicillin and Cotrimoxazole Antibiotics in Nairobi County; Brands Circulating in Selected Nairobi Retail and Hospital Pharmacies Ondicho J. , *Irungu B. N. , Koech C. L. Kigondu E. V. M. , Gathirwa J. W. , Mwikwabe N. , Orwa J. A, Keter L. *Presenting Author 6 th East African Health and Scientific Conference , 29 th -31 st March 2017 – Ecole Technique Professionnelle, Bujumbura - Burundi

Outline � Introduction � Objectives � Methods � Results � Summary

Introduction � The spread of poor quality drugs has been a global concern ; neglected public health problem � Poor quality drugs could have over or under concentration of API. They could also include products without API � Poor quality drugs; prolong illnesses, proliferate development of drug resistance � literature reveals that there is a concern on quality of antimicrobial medicines (Kelesidis et al. , 2007; Newton et al. , 2010; Attaran et al. , 2012) � most of the research focussing on antimalarial drugs (Basco, 2004; Amin et al. , 2005; Atemnkeng et al. , 2007; Nayyar et al. , 2012). � reports � on quality of antibiotics is minimal despite being in high demand

Why amoxicillin and cotrimoxale? Essential Medicines (KEML MOH 2016) � easily accessible; lowest level available for use is level 2 (dispensary/clinic) (KEML 2016) � Widely used; � ◦ cotrimoxazole is a broad spectrum antibiotic that provides benefits for adults and children, reducing morbidity and mortality especially to HIV infected individuals. ◦ Amoxicillin is used to treat many different types of bacterial infections , such as tonsillitis, bronchitis, pneumonia, gonorrhoea, and infections of the ear, nose, throat, skin, or urinary tract. previous studies ; some cotrimoxazole and amoxicillin samples failed quality tests. Abuga et al. , 2013, Kibwage at al. , 2013, Wafula et al. , 2016 � need for a study to evaluate quality of different brands in the Kenyan market �

Objectives 1. 2. 3. To establish brands of co-trimoxazole and amoxicillin in Nairobi County To identify and quantify active ingredients in co -trimoxazole and amoxicillin products. To establish dissolution profile of the solid dosages forms of the two drugs.

Methodology A cross-sectional study, conducted between March – April 2016. � Hospital and private Pharmacies selected from 11 regions in Nairobi County. � (Buruburu, CBD, Karen, Kasarani, Kayole, Kibera, South B and C Umoja, Westlands (including Kangemi) and Zimmerman) � Chemist sampled per region based on population size �

Methodology Cont’d � 1, 374 registered Pharmacy premises in Nairobi County as at 31/12/2015(PPB) �A representative statistical sample size of 302 pharmacies ; Krejcie and Morgan Table (1970) � Data collected from conveniently selected Pharmacies using standardized structured questionnaires � Details of each drug sample, such as Name, API, dosage strength, manufacturer’s details, etc. was captured

Results �Data collected from 298 Pharmacies (98. 7 % response ) 2898 samples documented (75. 6 % amoxicillin and 24. 4 % cotrimoxazole) � Drugs bearing the same brand name but different strengths eg Amoxicillin 250 mg and amoxicillin 500 mg were considered as different samples �

Results: Amoxicillin 88. 7 % of samples imported stocked by 99. 6% (297) pharmacies 2191 samples (58. 3 % single molecule; 41. 7% combination) grouped into 81 brand names ‘innovator brands imported from UK (50. 6 %), France (20. 6 %) and Belgium (19. 6%) Imported generics; India (45. 7%), Canada (13. 3 %), China (8. 4 %) Most stocked brand names; ◦ ◦ Amoxil. R 20. 9% Penamox 7. 7% Augmentin 15. 8% Clavulin 8. 5%

Results: Cotrimoxazole Stocked by 82. 2% (245) pharmacies 704 samples documented Grouped into 33 brand names Innovator brands; imported Egypt 72. 5%; UK 17 % Generics; India 75%; USA 14. 3 % Most stocked ◦ Septrin 25. 8% ◦ Cosatrim 22. 8% ◦ Biotrim 16. 5%

Results conti’d � 83 brand names of amoxicillin (single and combined) � 33 brand names of cotrimoxazole ◦ How do regulatory body police all these brand names post registration ? ◦ Are they all registered ? ◦ Which brand is superior than the other ?

600 Samples documented per region 564 500 Amoxicillin Frequency 400 Co-trimoxazole 297 249 244 146 34 9 53 m er m an s Zi m W Location 85 la nd ut h. C 38 So B ut h So er a 59 es t 64 e ra ni en Ka r CB D 21 Ka sa Bu ru bu ru 0 65 ol 51 79 121 a 100 Ka y 128 100 179 144 oj 162 Ki b 200 Um 300

Comparison between Kibera and Karen regions Kibera Informal settlement in Nairobi County Many ‘Pharmacies’ occupy small space Closer to each other 57 Pharmacies visited 249 samples of amoxicillin documented 85. 9 % of amoxicilln samples were generics (local and imported) Karen Affluent suburb of Nairobi few large Pharmacies Not very close 12 Pharmacies visited 100 samples of amoxicillin documented 62 innovator brands, 37 imported generics, one local generic

Summary � Amoxicillin was widely available in all the pharmacies visited, � ‘innovator brand names’ Amoxil. R, Augmentin and Septrin are readily available and most stocked Samples � Most of amoxicillin samples are imported (88. 7%) while cotrimoxazole samples were mainly local generics (66. 2 %) � NB: Work to establish quality (API and dissolution profiles in Progress)

Acknowledgements � IRG for the funds � Director KEMRI � Director CTMDR � Students at CTMDR �Asante �Merci