Substandard Quality Of The Antimicrobials Sold In The Streets Markets In Haiti

The World Health Organization estimates 1 in 10 medical products in low- and middle-income countries (LMIC) are substandard or counterfeit. Antibiotics and antimalarials are the most commonly counterfeit medicines. This could have a significant impact on public health and antimicrobial resistance, which may lead to devastating economic consequences.

A pilot study analyzed the quality of antimicrobials sold in the street markets in Port-au-Prince, Haiti. A total of 196 packs of 11 antimicrobials were analyzed using a Raman handheld spectrometer, where spectral match determines the authenticity of the drugs. Five of 11 antimicrobials had good or sufficient spectral matches. For six antimicrobials (tetracycline, erythromycin, cloxacillin, azithromycin, clarithromycin and amoxicillin-clavulanic acid), all of their tablets/capsules showed insufficient spectral match. In conclusion, there is a significant amount of counterfeit and substandard antimicrobials sold in street markets in Haiti. This study also showed that antimicrobials may be freely obtained without a prescription in street markets of Haiti.The low cost and time consumption gave rise to the popularity of medicine sales in street markets.

Additionally, this study method does not assess the quality of active ingredients nor does it determine the compounds in counterfeit medicines. Therefore, it is likely that degraded and/or mislabeled drugs are also sold in the street markets. All of these factors contribute to antimicrobial resistance.