Efficacy of Antibiotics Available Along the Borders of Low-income Countries: A Case of Tanzania and Implications for Public Health

The current generation of antibiotics is finding it harder and harder to cure bacterial illnesses in underdeveloped nations like Tanzania. Antibiotic resistance is facilitated by the widespread availability of substandard drugs, which puts the treatment of bacterial infections at risk. Antibiotics degrade more quickly when they are improperly stored or exposed to extreme tropical weather. Children under the age of five are estimated to suffer significant morbidity and mortality from infectious diseases, especially pneumonia and acute febrile illness when they lack access to conventional medical care, especially antibiotics. The majority of these incidents occur in low- and middle-income countries (LMICs).

Where antibiotic sellers are less common, where antibiotic prescriptions are tightly enforced, or where antibiotics are more costly, there is usually a lower consumption rate than in other settings, especially for mild conditions that probably don’t need antimicrobial treatment. Broad-spectrum antibiotics belonging to the Watch group of the World Health Organization's (WHO) AWaRe classification accounted for more antibiotic sales.

In Tanzania, over 60% of antibiotic and antimicrobial consumption is in accordance with WHO’s target and Tanzania’s Access component of the AWaRE classification. However, there is wide variation in the amount and types of antibiotics imported each year in the country, making it difficult to draw conclusions and identify meaningful trends going forward with regard to the consumption of certain classes of antibiotics.

The quality of imported medicine and methods for its assessment plays a major role in the effectiveness of therapies and the treatment of many infectious diseases. Poor-quality and/or falsified products are circulating in huge amounts in many LMICs, which is one of the major reasons why more and more resistant bacteria emerge. This conflicting finding calls for a better understanding of issues surrounding antibiotic access and use in LMICs because these countries simultaneously face high burdens of antimicrobial resistance.

Consequently, a need was felt to conduct a microbiological cross-sectional study on the quality of some antibiotics, selected from administrative regions along the borders of Tanzania. That study was complemented by a systematic literature search on the quality of antibiotics available in LMICs, with special emphasis on Tanzania. The microbiological analysis involved seventy-six antibiotics from 22 manufacturers, of which six were from anonymous manufacturers and 29 had no manufacturing or expiration dates. Different antibiotic samples of the same kind produced variable results. Ambiguous antibacterial profiles were exhibited by samples of ampicillin, chloramphenicol, cotrimoxazole, and amoxicillin as compared to their respective positive control antibiotics. The findings from the systematic review showed that in many cases, there were completely different active principal ingredients (APIs) compared to the declared ones. Therefore, these findings suggest the existence of counterfeit and/or substandard drugs in Tanzania, as significant variances in antibacterial effects were observed among antibiotics of the same type, which could have uncertain clinical outcomes.

The WHO describes substandard drugs as being “out-of-spec” and “authorized drugs that fail to meet either their quality standards or specifications, or both.” Substandard antibiotics may appear at the raw or crude API level because the antibiotic molecule may become unstable under specific storage circumstances or because there are too many potentially hazardous impurities.

Several factors have been pointed out to the availability of poor-quality antibiotics, which include weak penal sanctions, frail or absent national drug regulatory authorities, lack of proper drug law enforcement, lack of control of drugs for export, corruption, and conflict of interest, a dearth of political will and cooperation from stakeholders and other enforcers, just to mention a few.