Low Antibacterial Potency of Ceftriaxone Brands in Mbarara Municipality, Uganda
School of Public Health, College of Health Sciences, Makerere University, Uganda
*Corresponding Author: Anthony Ssebagereka, School of Public Health, College of Health Sciences, Makerere University, Uganda.
December 28, 2022; Published: January 06, 2023
Introduction: Antibiotic therapy has for a long time been a critical aspect of health care. Ceftriaxone is widely used for empirical antibacterial therapy among Healthcare facilities in Uganda. Antibacterial potency of ceftriaxone is the relative measure that compares doses of different brands required to produce the same bactericidal effect. Reports of widely differing antibiotic activity and clinical outcomes for ceftriaxone brands, from medical professionals, has raised many questions about their potency. The study aim was to determine the relative potency of the different ceftriaxone brands compared to the innovator brand.
Methods: Eleven Ceftriaxone brands on the market were obtained from the pharmacies and drug shops in Mbarara Municipality, including two brands obtained from the public hospital supply chain. Broth macro-dilution technique were used to determine the MIC (Minimum inhibitory concentration) and consequently, the MBC (Minimum Bactericidal Concentration) for each ceftriaxone brand against Escherichia coli (representative of gram negative bacteria) and Staphylococcus aureus (a representative of gram positive bacteria). Thereafter, the potency ratio (MBC of Innovator brand: MBC of a given ceftriaxone brand) was calculated.
Results: Generally, all the brands were found to be unreasonably less potent than the innovator (reference) brand. However, two brands had the lowest potency ratios (0.25% and 0.5%, respectively against Escherichia coli and 5% against Staphylococcus aureus), while the innovator brand and one other brand were the most potent brands (50% against Staphylococcus aureus and 100% against Escherichia coli), exhibiting the lowest MBCs. The two brands supplied in the public hospital, had percentage potency ratios of 10% and 40%, respectively against Staphylococcus aureus and 10% and 2.5%, respectively against Escherichia coli.
Conclusion: The ceftriaxone brands exhibited widely varying antibacterial activity with inferior bactericidal properties compared to the reference brand. Most of the ceftriaxone brands were largely bacteriostatic rather than bactericidal. In addition, the generic brands generally exhibited much lower potency against Staphylococcus aureus than Escherichia coli when compared with the reference brand. Further investigations ought to focus on quantification of the Active ingredient, chemical purity, and in-vivo activity of ceftriaxone brands, as well as monitor and assess efficacies and potencies for medicines especially antibiotics.
Keywords: Ceftriaxone; Anti-Bacterial Agents; Microbial Sensitivity Tests; Treatment Outcome
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