The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance

Author:

Cavany SeanORCID,Nanyonga Stella,Hauk Cathrin,Lim Cherry,Tarning JoelORCID,Sartorius BennORCID,Dolecek Christiane,Caillet Céline,Newton Paul N.,Cooper Ben S.ORCID

Abstract

AbstractApproximately 10% of antimicrobials used by humans in low- and middle-income countries are estimated to be substandard or falsified. In addition to their negative impact on morbidity and mortality, they may also be important drivers of antimicrobial resistance. Despite such concerns, our understanding of this relationship remains rudimentary. Substandard and falsified medicines have the potential to either increase or decrease levels of resistance, and here we discuss a range of mechanisms that could drive these changes. Understanding these effects and their relative importance will require an improved understanding of how different drug exposures affect the emergence and spread of resistance and of how the percentage of active pharmaceutical ingredients in substandard and falsified medicines is temporally and spatially distributed.

Funder

Wellcome Trust

Publisher

Springer Science and Business Media LLC

Subject

General Physics and Astronomy,General Biochemistry, Genetics and Molecular Biology,General Chemistry,Multidisciplinary

Reference81 articles.

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3. Ozawa, S. et al. Prevalence and estimated economic burden of substandard and falsified medicines in low- and middle-income countries: a systematic review and meta-analysis. JAMA Netw. Open 1, e181662–e181662 (2018).

4. Zabala, G. A. et al. Substandard and falsified antibiotics: neglected drivers of antimicrobial resistance? BMJ Glob. Health 7, e008587 (2022).

5. Newton, P. N. et al. Guidelines for field surveys of the quality of medicines: a proposal. PLoS Med. 6, e1000052 (2009).

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