title: Substandard and counterfeit antimicrobials: recent trends and implications to key public health interventions in developing countries.
abstract: OBJECTIVE
  The objective of this review is to produce evidence on the prevalence and trends in the availability of substandard and counterfeit antimicrobials in the global market and its consequences on key public health interventions in developing countries
  
  
  METHODS
  Review of various literatures collected through the internet and other sources. Literature search using PubMed and Medline databases and Google search engine was conducted to identify related publications on the subject. Relevant published and unpublished literature was also consulted as additional source of information.
  
  
  RESULTS
  During the past few decades, the trade of substandard and counterfeit medicines has increased substantially. Past experiences indicate that almost any kind of medicine can be counterfeited. In developing countries, primary targets are those antimicrobials that are commonly used in the treatment of life-threatening conditions including malaria, tuberculosis and HIV/AIDS. The findings in this review support the strong contention that substandard and counterfeit antimicrobials are available in the developing world in very high proportions. This is becoming one of the major causes of treatment failures leading to excessive mortality and morbidity. Moreover, it is implicated for contributing to the development of drug resistant organisms in many infectious diseases of public health significance such as malaria, tuberculosis and HIV/AIDS.
  
  
  CONCLUSIONS
  If trends in the prevalence of counterfeit/substandard drugs continue at the current scale, there is a huge threat to interventions underway on major killer diseases in the developing world. So, public health interventions in developing countries should include quality control of antimicrobials as an integral part of program implementation. The national drug regulatory authorities in those countries should also be strengthened to enhance their capacity in enforcing regulations pertaining the registration, production, distribution and use of antimicrobial drugs.
authors.affiliation: Management Sciences for Health (MSH), Addis Ababa, Ethiopia. hailutadeg@yahoo.com
authors.forename: Hailu
authors.initials: H
authors.lastname: Tadeg
authors.forename: Yemane
authors.initials: Y
authors.lastname: Berhane
mesh_terms: D000890:Anti-Infective Agents / Q000592:standards*; D058110:Counterfeit Drugs / Q000009:adverse effects; D003906:Developing Countries; D005607:Fraud / Q000517:prevention & control / Q000639:trends*; D006801:Humans; D004364:Pharmaceutical Preparations / Q000592:standards*; D011634:Public Health
chemical_list: D000890:Anti-Infective Agents; D058110:Counterfeit Drugs; D004364:Pharmaceutical Preparations