Fake Malaria Drugs Spread, Breed Resistance to Lethal Parasite

from Simeon Bennett, Bloomberg.com:

Fake malaria drugs from China are breeding resistance to life-saving medications in Cambodia and threatening to derail global efforts to eradicate the disease, a study funded by the Bill & Melinda Gates Foundation found.

Among more than 700 packets of pills sold at private drugstores in Cambodia and Thailand, 60 percent were found to be substandard or counterfeit around the border, compared with less than 5 percent in other areas in Thailand, said Patrick Lukulay, director of drug quality and information for U.S. Pharmacopeia, a Rockville, Maryland-based organization that tracks fake drugs.

Previous studies have suggested about one-third of malaria drugs in western Cambodia are fake, Lukulay said. Substandard treatments are contributing to growing resistance to genuine medicines in the area, he said. That threatens to unravel progress made against the disease in Africa, which has 90 percent of the world's malaria cases, if the resistant strain spreads there, researchers have warned.

"We did not expect a worsening of the situation," Lukulay said by phone from Phnom Penh yesterday. "We thought that by now things would have improved, but in fact they have not. The border areas are still notorious for having poor quality" medicines, he said.

Malaria strikes about 250 million people each year and kills more than 880,000, mostly children under age 5, according to the World Health Organization. It's the world's third- deadliest infectious disease, behind AIDS, which results in about 2 million deaths each year, and tuberculosis, which kills 1.6 million people annually, the Geneva-based WHO said.

Little Parasite

The disease is caused by a tiny parasite called Plasmodium, carried in the saliva of female mosquitoes. When an infected insect bites a person, the bugs travel to the liver, multiply and enter the bloodstream. There they invade red cells, leading to fever, chills, nausea and diarrhea. Unchecked, they cause red cells to stick to the walls of capillaries, slowing blood flow. Sufferers can die from organ failure without treatment.

The pills tested in the $350,000 Gates-funded study were mostly from China and touted to contain artesunate, part of a family of drugs called artemisinins that are the most potent weapons against malaria, Lukulay said. In reality, the study completed last week found that some had no active ingredient, while others contained small amounts, which fuel resistance by favoring the survival of the hardiest parasites, he said.

Treatments derived from artemisinin are taking almost twice as long to clear the parasites in patients in western Cambodia than in northwestern Thailand, showing the drugs are losing their potency against the disease, a study published in July in the New England Journal of Medicine showed.

Very Big Problem

"This is a very, very large problem potentially for the whole world," said Nick White, director of the Bangkok-based Mahidol Oxford Tropical Medicine Research Unit, which is studying drug-resistant malaria in the areas around the Thai- Cambodia border. "The scale and the speed of the response have been unfortunately too small," he said.

Researchers are still trying to understand why counterfeit malaria drugs are so abundant there, Lukulay said.

The WHO, which also participated in the drug-quality study, is trying to eliminate the resistant strain from that region with a mass screening and treatment program backed by $23 million from the Seattle-based Gates Foundation, the world's richest charity.

U.S. Pharmacopeia is seeking to raise awareness of counterfeit drugs in Cambodia with a campaign including television advertisements that it announced in Phnom Penh yesterday.

To contact the reporter on this story: Simeon Bennett in Singapore at sbennett9@bloomberg.net

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