Sale of fluoroquinolones in northern Tanzania: a potential threat for fluoroquinolone use in tuberculosis treatment.
OBJECTIVE
Fluoroquinolones have a potential role in shortening tuberculosis (TB) treatment duration. They are currently used in the treatment of other infections. This has raised concerns about development of mycobacterial resistance. The current study evaluates the sale of fluoroquinolones (among other antibacterials) in Moshi, Tanzania, a country with one of the highest burdens of TB in the world.


METHODS
Trained pharmacy assistants registered the sale of fluoroquinolones during February and March 2009 to outpatients in Moshi in all 14 pharmacies that are authorized to sell antibacterials for systemic use. The sale of all antibacterials of the Anatomical Therapeutic Chemical (ATC) J01 class was expressed in defined daily doses (DDDs) per 1000 inhabitants per day (DID). The availability of fluoroquinolones in drug outlets that are not authorized to sell antibacterials for systemic use was assessed in 15 randomly selected outlets in Moshi.


RESULTS
The sale of antibacterials to outpatients in Moshi by authorized pharmacies was 4.99 DID. The sale of fluoroquinolones was 0.62 DID (12% of total antibacterial sales). Ciprofloxacin was available in all 15 unauthorized drug outlets.


CONCLUSIONS
The substantial sales of fluoroquinolones by authorized pharmacies and the wide availability of fluoroquinolones in unauthorized drug outlets in Moshi constitute a challenge to the use of fluoroquinolones in TB treatment in Tanzania. Control of antibacterial use in Tanzania requires the implementation of surveillance systems for antibacterial use and resistance, and adequate restriction of antibacterial sales to authorized pharmacies only.
van den Boogaard
Jossy
J
Radboud University Nijmegen Medical Centre, The Netherlands. jossyvandenboogaard@gmail.com
Semvua
Hadija H
HH
Boeree
Martin J
MJ
Aarnoutse
Rob E
RE
Kibiki
Gibson S
GS
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003132:Commerce / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D010045:Outpatients; D013636:Tanzania; D014376:Tuberculosis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones