ArticleBMJ global health2022
Substandard and falsified antibiotics: neglected drivers of antimicrobial resistance?
Article in BMJ global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
51 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Substandard and falsified antimicrobials in selected east African countries: A systematic review.PloS one · 2024Pooled it
- Article
- Comparative Assessment of the Pharmaceutical Quality of Amoxicillin Capsules Marketed in Authorized and an Unregulated Point of Sale in Mexican Market.Therapeutic innovation & regulatory science · 2026Article
- Supply Chain Vulnerabilities in First-Line Treatments for Sexually Transmitted Infections: Implications for U.S. Public Health Preparedness.medRxiv : the preprint server for health sciences · 2026Article
- Substandard and Falsified Antibiotics Seized in Belgium: Quality Control Analysis Reveals High Prevalence of WHO Watch List Molecules and Bioavailability Non-Compliance.Antibiotics (Basel, Switzerland) · 2026Article
- Pharmabiome analyses in tandem with chemometrics can help trace the provenance of falsified medicines: A proof-of-concept study.Forensic science international. Genetics · 2026Article
- Article
- Tiered manufacturing of pharmaceuticals as a commercial determinant of health: Implications for medicine quality and equity.PLOS global public health · 2026Article
- Expanding AMR surveillance with the WHO's AWaRe classification: a nationwide occupational cohort study in Taiwan (2004-2020).BMJ public health · 2026Article
- Quality evaluation of cephalexin, cefuroxime, and ceftriaxone medicines marketed in Addis Ababa city, Ethiopia with three tier level approach and anti-microbial assays.BMC pharmacology & toxicology · 2025Article
- Knowledge and Practices on Household Disposal of Unused Antimicrobials in Ho Municipality, Ghana.International journal of environmental research and public health · 2025Article
- Post-market quality monitoring of medicines in Christian Health Association of Ghana health institutions.Ghana medical journal · 2025Article
- Medicine quality assessment in Nepal using semi randomised sampling and evaluation of a small scale dissolution test and portable Raman spectrometers.Scientific reports · 2025Article
- Article
- Packaging and High-Performance Liquid Chromatography Analysis of Amoxicillin Capsules from Nablus, Palestine.The American journal of tropical medicine and hygiene · 2025Article
- Substandard and falsified antibiotics are associated with antimicrobial resistance: a retrospective country-level analysis.BMJ global health · 2025Article
- Prioritising intervention areas for antimicrobial resistance in Nigeria's human and animal health sectors using a mixed-methods approach.One health (Amsterdam, Netherlands) · 2025Article
- 'Prevalence, experience and awareness of substandard and falsified medicines among the public and healthcare professionals in Jordan'.BMJ global health · 2025Article
- A Cost-Effective Liquid Chromatography Method with Ultraviolet Detection for Identity Screening and Assay of Injectable Antibiotics.Molecules (Basel, Switzerland) · 2025Article
- Investigation of CIP quality in over-the-counter drug stores of resource-limited countries: a comparative study in Vietnam and Nigeria.JAC-antimicrobial resistance · 2025Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectivesAntimicrobial resistance (AMR) is a significant global health threat with substandard and falsified (SF) antibiotics being neglected contributing factors. With their relationships poorly understood, more research is needed in order to determine how interventions to reduce SF antibiotics should be ranked as priorities in national AMR action plans. We assessed the evidence available on the global prevalence of SF antibiotics, examined the quality of the evidence and discussed public health impact. MATERIALS/
methodsWe searched PubMed, Embase, Google and Google Scholar for publications on antibiotic quality up to 31 December 2020. Publications reporting on the prevalence of SF antibiotics were evaluated for quantitative analysis and assessed using the Medicines Quality Assessment Reporting Guidelines.
resultsOf the 10 137 screened publications, 648 were relevant to antibiotic quality. One hundred and six (16.4%) surveys, published between 1992 and 2020 and conducted mainly in low-income and middle-income countries (LMICs) (89.9% (480/534) of the data points), qualified for quantitative analysis. The total number of samples tested for quality in prevalence surveys was 13 555, with a median (Q1-Q3) number of samples per survey of 47 (21-135). Of the 13 555 samples, 2357 (17.4%) failed at least one quality test and the median failure frequency (FF) per survey was 19.6% (7.6%-35.0%). Amoxicillin, sulfamethoxazole-trimethoprim and ciprofloxacin were the most surveyed antibiotics, with FF of 16.1% (355/2208), 26.2% (329/1255) and 10.4% (366/3511), respectively. We identified no SF survey data for antibiotics in the WHO 'Reserve' group. The mean Medicine Quality Assessment Reporting Guidelines score was 11 (95% CI 10.1 to 12.2) out of 26.
conclusionsSF antibiotics are widely spread with higher prevalence in LMICs. The quality of the evidence is poor, and these data are not generalisable that 17.4% of global antibiotic supply is SF. However, the evidence we have suggests that interventions to enhance regulatory, purchasing and financial mechanisms to improve the global antibiotic supply are needed. PROSPERO REGISTRATION NUMBER: CRD42019124988.
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