title: Deteriorated tuberculosis drugs and management system problems in lower southern Thailand.
abstract: METHODS
  Three institutes, 11 hospitals and 38 community hospitals in southern Thailand.
  
  
  OBJECTIVE
  To assess the quality of tuberculosis (TB) drugs used in TB treatment facilities in southern Thailand and their TB drug management systems.
  
  
  METHODS
  Cross-sectional study utilising interviews, document review, inspection of drug storage, visual examination of TB drugs, and laboratory analysis of samples of isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA) and ethambutol (EMB).
  
  
  RESULTS
  No stock-out of TB drugs was found at any level. Thirteen (25%) hospitals/institutes removed coated EMB tablets from their foil packages for daily dose packing. Eleven (21%) hospitals/institutes bisected 400 mg coated EMB tablets before dispensing as a non-available 200 mg tablet. On the day of inspection grossly deteriorated EMB was observed in 44% of hospitals/institutes. All samples, except 14% of EMB, passed content assay tests. All INH and EMB samples passed the dissolution tests, but 62% of RMP samples and 26% of PZA samples failed.
  
  
  CONCLUSIONS
  Sub-standard deteriorated TB drugs are a serious problem for TB control. TB drugs examined in the study area were not managed properly. Education on TB drug packaging and storage, and non-destructive systems in TB drug distribution, storage, inventory control, quality assurance and supervision are essential interventions.
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand. korn_gamon@yahoo.com
authors.forename: K
authors.initials: K
authors.lastname: Rookkapan
authors.forename: V
authors.initials: V
authors.lastname: Chongsuvivatwong
authors.forename: S
authors.initials: S
authors.lastname: Kasiwong
authors.forename: S
authors.initials: S
authors.lastname: Pariyawatee
authors.forename: Y
authors.initials: Y
authors.lastname: Kasetcharoen
authors.forename: P
authors.initials: P
authors.lastname: Pungrassami
mesh_terms: D000995:Antitubercular Agents / Q000032:analysis / Q000592:standards* / Q000600:supply & distribution*; D003430:Cross-Sectional Studies; D004349:Drug Packaging; D004355:Drug Stability; D004356:Drug Storage; D006801:Humans; D008509:Medication Systems / Q000592:standards*; D011785:Quality Assurance, Health Care; D011786:Quality Control; D013785:Thailand
chemical_list: D000995:Antitubercular Agents