title: The need for better data about counterfeit drugs in developing countries: a proposed standard research methodology tested in Chennai, India.
abstract: OBJECTIVE
  There is still surprisingly little basic research data to support widely repeated claims about the prevalence of drug counterfeiting. To meet the need for more reliable drug quality data, we designed a study framework that includes clear definitions of measured end points, sampling methods and assay technique. Our objective was to test this research design in Chennai (formerly Madras), India, using a joint Indian and Canadian team.
  
  
  METHODS
  The city was divided into ten areas along municipal lines. From each area, ten stores and pharmacies selling drugs were selected. At each of these 100 outlets, three study drugs (artesunate, ciprofloxacin and rifampicin) were purchased. The 300 samples were tested by Liquid Chromatography-Mass Spectrometry. Assay content was expressed as a percentage of stated tablet content. Based on assay results and their distribution, we developed drug quality definitions for normal manufacturing standards, counterfeiting, decomposition, poor quality control and adulteration.
  
  
  RESULTS
  The group mean for ciprofloxacin was close to normal manufacturing limits (99·2 ± 7·1%) but rifampicin (91·6 ± 5·7%), and artesunate (80·1 ± 9·1%), were both below normal pharmaceutical standards. Overall, 43% of all samples fell below the widely accepted manufacturing range of 90-110% of stated content. No tablet from any sample contained less than 50% of the stated dose.
  
  
  CONCLUSIONS
  The quality of at least some anti-infective drugs in Chennai is below commonly accepted standards but we found no evidence of criminal counterfeiting. Poor drug quality was most likely due to decomposition during storage or poor manufacturing standards. Our research methodology worked well under practical conditions and should hopefully be of value to others working in this area.
authors: Centre for International Child Health Department of Pharmacy, Children's and Women's Hospital, Vancouver, BC, Canada. mseear@cw.bc.ca
authors: M
authors: M
authors: Seear
authors: D
authors: D
authors: Gandhi
authors: R
authors: R
authors: Carr
authors: A
authors: A
authors: Dayal
authors: D
authors: D
authors: Raghavan
authors: N
authors: N
authors: Sharma
mesh_terms: D037621:Artemisinins / Q000032:analysis / Q000737:chemistry / Q000592:standards*; D000077332:Artesunate; D002853:Chromatography, Liquid; D002939:Ciprofloxacin / Q000032:analysis / Q000737:chemistry / Q000592:standards*; D058110:Counterfeit Drugs / Q000032:analysis*; D003906:Developing Countries; D004340:Drug Contamination; D004355:Drug Stability; D004356:Drug Storage; D006801:Humans; D007194:India; D013058:Mass Spectrometry; D011786:Quality Control; D012107:Research Design; D012293:Rifampin / Q000032:analysis / Q000737:chemistry / Q000592:standards*
chemical_list: D037621:Artemisinins; D058110:Counterfeit Drugs; D002939:Ciprofloxacin; D000077332:Artesunate; D012293:Rifampin