Lab on paper: assay of beta-lactam pharmaceuticals by redox titration

Myers, Nicholas M.; Maina, Mercy; Were, Phelix Makoto; Karwa, Rakhi; Pastakia, Sonak D.; Sharp, Jalen C.; Luther, Jamie L.; Cooper, A.; Bliese, Sarah L.; Oberhof, Nils; Aldulaimi, Doaa; Lieberman, Marya

doi:10.1039/c9ay01547g

Cited by 10 publications

(16 citation statements)

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“…For instance, we utilized the brand market share and prevalence of substandard and falsified amoxicillin from our recent testing of samples from Western Kenya. 7 While there may be other brands of amoxicillin available on the national market, and market share may vary across regions, national-level data were not available. Furthermore, we utilized a regional estimate for the incidence of pneumonia for children under five.…”

Section: Discussionmentioning

confidence: 99%

“…Table 1 includes all inputs used to run the model. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Throughout each scenario, we estimated the costs required to perform medicine quality screening and testing. These investment costs included: (1) testing costs incurred by implementing PADs/aPADs and/or HPLC; (2) wastage costs incurred by consuming medications through screening and testing procedures; and (3) costs of personnel to sample medicines and later remove failed batches from the market.…”

Section: Paper Analytical Devices (Pads) Scenariomentioning

confidence: 99%

“…6 The sensitivity and specificity of the PAD to detect falsified amoxicillin are 100% and 100%, respectively. 6,7 In addition, for beta-lactam antibiotics, an antibiotic paper analytical device (aPAD) has been developed to identify substandard antibiotics. Specifically, aPADs measure the API concentration to see if the drug quantity is within pharmacopeial standards (usually 90%-110%).…”

Section: Introductionmentioning

confidence: 99%

“…The aPAD is based on USP method <425>, which requires base degradation of a beta-lactam sample, neutralization, addition of excess iodine, and a back-titration. 7,8 By adding drops of the sample to the aPAD card and counting the number of dots that turn blue, the API concentration is measured with an accuracy of ±5%. The sensitivity and specificity of the aPAD to detect substandard amoxicillin (<90% API content) are 97% and 92%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Cost savings of paper analytical devices (PADs) to detect substandard and falsified antibiotics: Kenya case study

Chen

Higgins

Laing

et al. 2021

Medicine Access @ Point of Care

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Background: Over 10% of antibiotics in low- and middle-income countries (LMICs) are substandard or falsified. Detection of poor-quality antibiotics via the gold standard method, high-performance liquid chromatography (HPLC), is slow and costly. Paper analytical devices (PADs) and antibiotic paper analytical devices (aPADs) have been developed as an inexpensive way to estimate antibiotic quality in LMICs. Aim: To model the impact of using a rapid screening tools, PADs/aPADs, to improve the quality of amoxicillin used for treatment of childhood pneumonia in Kenya. Methods: We developed an agent-based model, ESTEEM (Examining Screening Technologies with Economic Evaluations for Medicines), to estimate the effectiveness and cost savings of incorporating PADs and aPADs in amoxicillin quality surveillance in Kenya. We compared the current testing scenario (batches of entire samples tested by HPLC) with an expedited HPLC scenario (testing smaller batches at a time), as well as a screening scenario using PADs/aPADs to identify poor-quality amoxicillin followed by confirmatory analysis with HPLC. Results: Scenarios using PADs/aPADs or expedited HPLC yielded greater incremental benefits than the current testing scenario by annually averting 586 (90% uncertainty range (UR) 364–874) and 221 (90% UR 126–332) child pneumonia deaths, respectively. The PADs/aPADs screening scenario identified and removed poor-quality antibiotics faster than the expedited or regular HPLC scenarios, and reduced costs significantly. The PADs/aPADs scenario resulted in an incremental return of $14.9 million annually compared with the reference scenario of only using HPLC. Conclusion: This analysis shows the significant value of PADs/aPADs as a medicine quality screening and testing tool in LMICs with limited resources.

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Section: Discussionmentioning

confidence: 99%

Section: Paper Analytical Devices (Pads) Scenariomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cost savings of paper analytical devices (PADs) to detect substandard and falsified antibiotics: Kenya case study

Chen

Higgins

Laing

et al. 2021

Medicine Access @ Point of Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…85 to integrate a paper analytic device, which has been locally tested and validated, requires no electricity and minimal expertise, for qualitative testing of suspected poor-quality medicines. 94 Utilizing a memorandum of understanding can also help to ensure that all parties recognize their role for a mutually beneficial partnership. The local experience a pharmacist acquires identifying and addressing health challenges can be spread through advocacy and informing key political stakeholders.…”

Section: Research Ethics Committees and Conducting Researchmentioning

confidence: 99%

American College of Clinical Pharmacy Global Health Practice and Research Network's opinion paper: Pillars for global health engagement and key engagement strategies for pharmacists

Crowe

Karwa

Schellhase

et al. 2020

J Am Coll Clin Pharm

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The scope of pharmacy practice in global health has expanded over the past decade creating additional education and training opportunities for students, residents and pharmacists. There has also been a shift from short‐term educational and clinical experiences to more sustainable bidirectional partnerships between high‐income countries (HICs) and low‐ to middle‐income countries (LMICs). As more institutional and individual partnerships between HICs and LMICs begin to form, it is clear that there is a lack of guidance for pharmacists on how to build meaningful, sustainable, and mutually beneficial programs. The aim of this paper is to provide guidance for pharmacists in HICs to make informed decisions on global health partnerships and identify opportunities for engagement in LMICs that yield mutually beneficial collaborations. This paper uses the foundations of global health principles to identify five pillars of global health engagement when developing partnerships: (a) sustainability, (b) shared leadership, (c) mutually beneficial partnerships, (d) local needs‐based care and (e) host‐driven experiential and didactic education. Finally, this paper highlights ways pharmacists can use the pillars as a framework to engage and support health care systems, collaborate with academic institutions, conduct research, and interface with governments to improve health policy.

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Evaluating the impact of a 15‐year academic partnership to promote sustainable engagement, education, and scholarship in global health

Karwa

Miller

Schellhase

et al. 2020

J Am Coll Clin Pharm

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IntroductionIn 2003, Purdue University College of Pharmacy (PUCOP) in West Lafayette, Indiana, began the Purdue Kenya Partnership (PKP) in collaboration with the Academic Model Providing Access to Healthcare, Moi University, and Moi Teaching and Referral Hospital, in Eldoret, Kenya. PUCOP's involvement utilized a tripartite approach of engagement, education, and scholarship to provide and expand sustainable access to high quality care.ObjectiveThis paper discusses outcomes and impacts of this academic partnership.MethodsPurdue Kenya Partnership's progress in achieving its stated mission was evaluated using an outcome‐approach logic model. This model highlighted inputs, activities, and results which encompassed outputs, outcomes, and impact. A comprehensive set of ratios were calculated to quantify annual change in PKP investments against estimated metrics for engagement, education, and scholarship. These metrics were weighted by involvement level and pharmacist effort in various clinical domains. Descriptive statistics were completed that identified cumulative and totals per year for each collected data type of data collected.ResultsPurdue Kenya Partnership implementation utilized initial inputs of human resources, financial capital, and strategic partnerships. These inputs supported pharmacy involvement in 16 distinct care programs in both inpatient and outpatient settings which supported the care of 457 833 individual patients and grown a clinical pharmacy staff from 0 to 22 practicing clinical pharmacists. Five unique educational programs have been established which have graduated 457 trainees. Purdue Kenya Partnership has generated over $6.2 million in grant funding and disseminated 302 peer reviewed manuscripts, posters, and oral presentations combined. Ratios describing trends in engagement, education, and scholarship as a result of using the locally focused PKP approach highlight higher initial costs compared with much lower costs per outcome several years into the partnership.ConclusionThe PKP's global health approach of prioritizing the population's care needs (“leading with care”) has enabled the development of sustainable engagement, education, and scholarship infrastructure with significant gains in all three domains.

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Lab on paper: assay of beta-lactam pharmaceuticals by redox titration

Abstract: This paper test card can identify ampicillin or amoxicillin formulations that contain <90% of the stated API content.

Cited by 10 publications

References 13 publications

Cost savings of paper analytical devices (PADs) to detect substandard and falsified antibiotics: Kenya case study

Cost savings of paper analytical devices (PADs) to detect substandard and falsified antibiotics: Kenya case study

American College of Clinical Pharmacy Global Health Practice and Research Network's opinion paper: Pillars for global health engagement and key engagement strategies for pharmacists

Evaluating the impact of a 15‐year academic partnership to promote sustainable engagement, education, and scholarship in global health

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