NEWS: TB patients get expired drug

TB patients get expired drug

Tuesday, April 14th, 2009 from MONITOR ONLINE:

A shortage of tuberculosis drugs, which has spanned six months in some hospitals in the country, is forcing doctors to resort to using already expired drugs to treat their patients, a Daily Monitor investigation reveals.

Daily Monitor has learnt that doctors at Gulu Main Referral Hospital are treating their patients using drugs that expired as long ago as February 2006. The drugs have been at the hospital stores more than three years since they expired due to the hospital’s lack of facilities to dispose them off, but the medics are not using them out of desperation.

DANGEROUS: Expired TB drugs at Gulu Hospital. PHOTO BY PAUL AMORU
Investigations by this paper reveal that both in-patients and out-patients at the hospital have been receiving the expired drugs for nearly three months now. Efforts by Daily Monitor to establish the total number of TB patients now ‘surviving’ on this toxic medication were not fruitful.

But well-placed sources at the hospital, who declined to be named because of the sensitivity of the matter, disclosed that the expired drugs are mainly given to patients who developed MDR TB. Our source identified the expired medication as Streptomycin Sterile Injection.. “Drugs like Streptomycin Sterile, Ethambutol and Isoniazed tablets expired in January but patients who developed resistance are still relying on expired streptomycin injection,” the source explained.

“Following an expiration date is important, no matter what is in question. The facts are that the item (drug) in question has been found that under normal conditions it only remains effective for a set amount of time. After this time, the drug becomes ineffective, meaning it is pointless to even take it, and at times it can even become harmful,” our source, who is a practicing doctor, explained.

There is a high risk of TB transmission, which is actually heightened when a patient’s treatment regime is interrupted by a shortage or use of expired drugs as in the Gulu case. Since most of these patients had already developed multi-drug resistance (MDR) TB, relying on expired drugs at such a critical stage of their treatment can only lessen their chances of ever getting well.

Gulu Referral Medical Superintendent, Dr Agel Yoventino Akii, said while some expired drugs had in the past been used to treat people, the practice had now been phased out.“Sometime back the expiry date of these (TB) drugs was short and the hospital had to use it. But now we (Gulu hospital) have already received new stock and we are still considering whether to include new (TB) cases to receive drugs,” Dr Akii said without indicating when the new stock arrived in the district.

However, our sources insisted that no new drugs had been delivered to the hospital store and it is the reason the expired medication was secretly being administered to patients.

The Hospital In-Charge of Tuberculosis ward, Sr. Louise Anger, said the last consignment of drugs from the Directorate of Health Services for the month of January had their expiry dates for February and they are out of stock. “We collected 576 packets of TB drugs from the director’s office for January and we finished them but what we have are okay,” Sr. Anger said without indicating that they had received new stock after January.

News of a stock-out of TB drugs in the country broke at the time when the world was preparing to celebrate and commemorate the lives of those who have been affected by TB across the globe. Dr Sam Zaramba, the director general of health services, last month confirmed the shortage but denied reports that patients were being given expired drugs at any government hospital in the country.

The district Tuberculosis and Leprosy Focal Point Person, Mr John Opwonya, while downplaying the issue of expired medication, said there were no TB drugs in the store.Gulu district health officer Dr Paul Onek said, “The supply of ARV drugs is fair but for TB is poor. The last consignment we received was in January which lasted only for a month and now we are borrowing from sources with support from MSF Spain.”

Media reports show that since October 2008, Mulago Hospital has been experiencing shortages of anti-TB drugs. Mr Vincent Uma, a former police officer who is on his six month treatment in TB ward, explained that there was constant treatment although so difficult to determine if injections he received were expired.