Evaluation of bacteriostatic potency of expired oral paediatric antibiotics and implications on infant health

Abstract

IntroductionIn spite of significant risks, as well as non-clinical importance due to loss of potency, stiff penalties against administration of expired medications are still not appropriately enforced by health policy makers in many developing countries, possibly because of little evidence to support that expired medications are hazardous. The purpose of this study therefore, was to investigate the effect of expiration dates on in vitro bacteriostatic potentials of oral paediatric antibiotics.MethodsComparative bacteriostatic potentials of 31 expired and seven corresponding unexpired oral paediatric antibiotics were determined on infantile diarrhoeagenic bacteria, using a modification of agar well-diffusion method.ResultsVerall total percentage in vitro resistance rates against expired and unexpired paediatric antibiotics respectively were - E. coli (≤100% vs. ≤15.9%), Klebsiella pneumoniae (≤100% vs. ≤31.3%), Proteus mirabilis (≤91.7% vs. ≤41.7%) and Staphylococcus aureus (≤100% vs. ≤18.2%). Resistance rates of 45.5-55.8% (sulfamethoxazole + trimethoprim 5), 39.5-63.6% (amoxycillin 6), 46.5-54.5% (cotrimoxazole 7), 37.5-63.6% (ampicillin + cloxacillin 18), and higher resistance rates of ≥75.0-100% were exhibited towards remaining expired antibiotics. Higher total resistance and multiple antibiotic resistance (MAR) rates were also recorded against expired antibiotics (45.2-93.5%) compared to unexpired antibiotics (28.6-57.2%), except for few strains of E. coli and Proteus mirabilis. Furthermore, unexpired paediatric antibiotics exhibited wider zones of inhibition towards the test diarrhoeagenic bacteria (≥25.0 mm diameter).ConclusionThis study provided preliminary microbiological results on the appreciable reduction in in vitro bacteriostatic potentials, as well as higher resistance and multiple antibiotic resistance rates among expired oral paediatric antibiotics on infantile diarrhoeagenic bacteria. Apart from less-efficacy, administration of expired antibiotics can lead to increased antibiotic resistance and clinical treatment failure, as well as adverse drug reactions.

<p>Knowledge, Attitude, and Practice on Over-the-Counter Drugs Among Pharmacy and Medical Students: A Facility-Based Cross-Sectional Study</p>

“…Some products may also get degraded if used after their expiration date and the products of degradation are significantly more toxic than the original active pharmaceutical ingredient. 39 Another risky behavior was also observed among the respondents in which a significant number of the participants reported that they will double the dose if the OTC medication they used has failed. Taking medications above their recommended dose is one of the most common factors for the various ADRs incurred by medications, and these kinds of malpractices have also been documented with the use of OTC medications.…”

Global contributors to antibiotic resistance

“…[8] It has also been shown that the use of expired pediatric antibiotics led to higher rates of resistance when compared to unexpired medicines. [9] Resistance rates are in fact increased by 2–6 fold when using expired medications compared to unexpired medications. Substandard and expired antibiotics are sold for a number of reasons.…”

“…Substandard and expired antibiotics are sold for a number of reasons. [9] The expiration date printed gives consumers information about the shelf life of a medicine given that it is stored in proper conditions of light, temperature, and moisture. [10] However, high temperatures, harsh sunlight, and humidity can all lead to antibiotic degradation.…”

Practices About Antibiotic Use Among Urban Residents: A Cross-Sectional Survey in Rufisque, Senegal

“…Most respondents were in the age group [31][32][33][34][35][36][37][38][39][40] years (32.5%), male (55%) and married (55.5%). They were employed in most cases (62%).…”

“…Populations should be made aware of the importance of checking the expiry date of medicines. Indeed, a study conducted in Nigeria showed that expired antibiotics may have clinical consequences such as resistance, side effects and treatment failure [38].…”