Antimicrobial Resistance: What Does Medicine Quality Have to Do with It?
(2015; 45 pages)


This paper contributes to the Review of Antimicrobial Resistance commissioned by the UK Prime Minister and chaired by Jim O'Neill by reviewing what is known about the contribution that poor quality medication makes to the development of antimicrobial resistance. It presents information about the prevalence and distribution of poor quality antimicrobial medicines globally, attempting to distinguish between the various types of poor quality medicines on the market, and examines the ways in which they may promote resistance. The paper identifies information gaps, and recommends action that might be taken to minimise the likelihood that poor quality medication becomes entrenched as yet another driver of antimicrobial resistance worldwide.

The overwhelming majority of information about anti-infective medicine quality concerns anti-malarials; indeed the public health community's renewed interest in medicine quality was sparked in part by evidence that parasites resistant to the relatively new, fast-acting antimalarial artemisinin were emerging in Southeast Asia. While studies linking low quality medicines directly to antimicrobial-resistant pathogens remain vanishingly rare, there's considerable evidence showing that subtherapeutic doses of medicines do contribute to the development and spread of resistance.

It is important to note that poor quality medicine can be critically damaging to public health in many ways beyond promoting anti-microbial resistance. Falsified medicines with no active ingredients leave both chronic and infectious diseases untreated, prolonging illness and the expense of treatment, and sometimes leading to death. For many infectious diseases including HIV and malaria, treatment failure leads to increased pathogen loads and thus increases the chance of infections being passed on. Fake vaccines, for their part, allow a person who would otherwise develop immunity to remain susceptible to infection. Poorly made or mislabelled medicines containing the wrong ingredients can be toxic, again killing the people who take them in the hope of a cure. Medication scares undermine public confidence in the health system, and the massive trade in fake medicine fuels and funds criminal networks while siphoning income away from legitimate business. These issues are, however, beyond the scope of this paper; here we focus only on those issues which affect or are affected by antimicrobial resistance.

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