Travellers visiting malaria hotspots have been warned to be on their guard after doctors in Spain treated a woman who was sold fake antimalarial drugs in Equatorial Guinea.
A case report published in The Lancet this week revealed that the woman became dangerously ill after buying the counterfeit tablets.
Dr Carlos Chaccour, of the Division of Internal Medicine and Infectious Diseases, Clinica Universidad de Navarra, said how the 28-year-old woman’s condition deteriorated in hospital after her return from the African country.
Doctors treated her with her own artesunate while they waited for an official supply of artesunate, which is available only via the ministry of health in Spain
When the government approved drugs arrived, she made a full recovery within three days and was discharged.
Tests carried out by the London School of Hygiene and Tropical Medicine on the artesunate that the patient had bought found that the tablets contained no artesunate. High performance liquid chromatography and mass spectrometry confirmed that the tablets contained no active pharmaceutical ingredient.
The package, which was also compared with genuine ones bought in Africa, had several spelling mistakes, a fake company registration number, and other differences in design.
“Counterfeit and substandard anti-malarial drugs can effectively kill people taking them in endemic areas,” write the authors.
“They may also have a role in the genesis of resistance, since some samples have been found to contain sub-therapeutic quantities of artesunate. Exposure of malaria parasites to sub-therapeutic drug concentrations favours the selection of resistant strains.
“Losing artemisinin to resistance in Africa would seriously hinder control efforts. Counterfeit drugs should be considered as a cause of treatment failure, and global efforts to discourage the commercialisation of artemisinin-based monotherapies must continue with further international consensus taken to counteract the fake drug trade.”
In May 2012, a review in The Lancet Infectious Diseases warned that up to one third of antimalarial drugs sold worldwide could be fake.
Travel and fake artesunate: a risky business. Chaccour CJ et al. The Lancet. Vol 380 September 22 2012. Lancet 2012; 380: 1120
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