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  • br Antimicrobial drugs are the most counterfeit or substanda

    2019-05-23


    Antimicrobial drugs are the most counterfeit or substandard drugs worldwide. The pharmacopoeial quality of these drugs in China is of special concern because China is the second producer, after India, of most counterfeit or substandard drugs in the global market. The antimicrobials circulating in China are produced by local, joint-venture, or foreign pharmaceuticals. There were 4875 local pharmaceutical manufacturers in China in 2013, most of which were small-sized or medium-sized. Although the central government aimed to minimise the number of pharmaceutical manufacturers and to improve drug quality by increasing the severity of punishment for forgery, the progress has been slow with only minor changes in the related policies and surveillance on pharmaceutical manufacturers and 414 840 pharmacies across China. Loose regulations and laws (eg, the maximum penalty of 1000 RMB [1 RMB≈0·1 GBP] for the sale of prescription drugs without prescription) greatly contribute to the great increase in non-prescription antimicrobial drugs and underline the problem of drug resistance in China. Moreover, storage conditions in domestic pharmacies are usually suboptimal with unknown effects on the pharmacopoeial quality of medicines. The reported prevalence of counterfeit or substandard medicines is 1–2% on the ; one available official report cites the prevalence of counterfeit or substandard antimicrobials in 2007 as 1·9%, which is much lower than the 22–38% prevalence reported in other low-income and middle-income countries. Therefore, in a cross-sectional study, we independently investigated the pharmacopoeial quality of five common antimicrobial drugs (amoxicillin, azithromycin, cefuroxime axetil, levofloxacin, and metronidazole) from INNO-406 pharmacies in Shantou, southern China, with a population of 5·1 million. We selected the five antimicrobial drugs representing common antimicrobial classes—penicillins, macrolides, cephalosporins, quinolones, and imidazoles—because they were (1) commonly used in hospitals and community pharmacies, (2) sensitive to degrade under unsatisfied storage conditions, (3) frequently reported to have no active ingredient, and/or (4) included in the National Essential Drug List of China, as described previously. Of note, levofloxacin and cefuroxime axetil were first and third among the top 10 consumed antimicrobials in 360 hospitals in China during 2005–08.
    In , Jun Zhu and colleagues provide stillbirth rates retrieved from China\'s National Maternal Near Miss Surveillance System between 2012 and 2014. The authors found the stillbirth rate was particularly high in young women (aged <15 years). However, this study overlooks the demographic impact of China\'s population policy shift at present. With the implementation of the two-child policy in 2016, we presume that the age group of women at high risk of stillbirth might shift to older women. Data from WHO indicated that the prevalence of cesarean sections in the past 10 years in China was significantly higher than WHO\'s recommended proportion. The one-child policy might have contributed indirectly to this increase. Parents who can have only one child might opt for what is perceived to be the safest delivery option. In 2015, however, the Communist Party of China Central Committee has substantially relaxed its one-child policy and has shifted to a two-child policy to balance population growth and offset the burden of an ageing population. Some women who had their first child with caesarean section during the one-child policy period stand a good chance to choose to have their second child now, as they are more mature mentally and economically than before. However, those women with their growing age (>35 years) might have higher risk of stillbirth during pregnancy. Indeed, several population-based studies showed that in women with previous caesarean delivery, the risk of unexplained antepartum stillbirth at or after 39 weeks\' gestation was about double the risk of stillbirth or neonatal death from intrapartum uterine rupture. Therefore, the Government in China need to pay more attention to enhance the quality of antenatal care for pregnant women who had one previous caesarean delivery, particularly for older parturient women among them.