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Quality Testing of Artemisinin-Based Antimalarial Drugs in Myanmar

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  • 1 College of Agronomy and Biotechnology, China Agricultural University, Beijing, China;
  • | 2 Myanmar Medical Association, Yangon, Myanmar;
  • | 3 College of Agriculture, Guangxi University, Nanning, Guangxi, China;
  • | 4 Breeding Base of Guangxi Key Laboratory of Agri-Environment and Agri-Products Safety, Nanning, Guangxi, China;
  • | 5 Department of Entomology, Pennsylvania State University, University Park, Pennsylvania

Artemisinin-based combination therapies are the frontline treatment of Plasmodium falciparum malaria. The circulation of falsified and substandard artemisinin-based antimalarials in Southeast Asia has been a major predicament for the malaria elimination campaign. To provide an update of this situation, we purchased 153 artemisinin-containing antimalarials, as convenience samples, in private drug stores from different regions of Myanmar. The quality of these drugs in terms of their artemisinin derivative content was tested using specific dipsticks for these artemisinin derivatives, as point-of-care devices. A subset of these samples was further tested by high-performance liquid chromatography (HPLC). This survey identified that > 35% of the collected drugs were oral artesunate and artemether monotherapies. When tested with the dipsticks, all but one sample passed the assays, indicating that the detected artemisinin derivative content corresponded approximately to the labeled contents. However, one artesunate injection sample was found to contain no active ingredient at all by the dipstick assay and subsequent HPLC analysis. The continued circulation of oral monotherapies and the description, for the first time, of falsified parenteral artesunate provides a worrisome picture of the antimalarial drug quality in Myanmar during the malaria elimination phase, a situation that deserves more oversight from regulatory authorities.

Author Notes

Address correspondence to Baomin Wang, College of Agronomy and Biotechnology, China Agricultural University, Beijing 100193, China, E-mail: wbaomin@263.net or Liwang Cui, Department of Entomology, Pennsylvania State University, University Park, PA 16802, E-mail: luc2@psu.edu

These authors contributed equally to this work.

Financial support: This research was supported by National Institute of Allergy and Infectious Diseases, National Institutes of Health (U19AI089672).

Authors’ addresses: Suqin Guo, Xiangxue Ning, Wei Zhang, and Baomin Wang, China Agricultural University, College of Agronomy and Biotechnology, Beijing, China, E-mails: guosuqin074910@163.com, gainknight@gmail.com, zhangwei12@cau.edu.cn, and wbaomin@263.net. Myat Phone Kyaw and Myo Min, Myanmar Medical Association, Malaria Control, Yangon, Yangon Region, Myanmar, E-mails: kyaw606@gmail.com and myomin27@gmail.com. Lishan He, Guangxi University, College of Agriculture, Nanning, China, E-mail: hls0305@163.com. Liwang Cui, Penn State University, Entomology, University Park, Pennsylvania, E-mail: luc2@psu.edu.

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