Since the 1990s, several mass poisonings from toxic cough syrup have occurred in developing countries. In these cases, an ingredient in cough syrup,

glycerine Glycerol (), also called glycerine in British English and glycerin in American English, is a simple triol compound. It is a colorless, odorless, viscous liquid that is sweet-tasting and non-toxic. The glycerol backbone is found in lipids know ...

(glycerol), was replaced with

diethylene glycol Diethylene glycol (DEG) is an organic compound with the formula (HOCH2CH2)2O. It is a colorless, practically odorless, and hygroscopic liquid with a sweetish taste. It is a four carbon dimer of ethylene glycol. It is miscible in water, alcohol ...

, a cheaper alternative to glycerine for industrial applications. Diethylene glycol is

nephrotoxic Nephrotoxicity is toxicity in the kidneys. It is a poisonous effect of some substances, both toxic chemicals and medications, on kidney function. There are various forms, and some drugs may affect kidney function in more than one way. Nephrotoxins ...

and can result in multiple organ dysfunction syndrome (MODS), especially in children.

History

There have been poisonings in Panama, China, Haiti, Bangladesh, Argentina, Nigeria, India (twice), Indonesia, Uzbekistan and The Gambia between 1992 and 2022, due to contaminated cough syrup and other medications that incorporated inexpensive

instead of

Bangladesh

Discovering and tracing a toxic syrup to its source has been difficult for health care providers and governmental agencies due to difficult communication between the governments of developed countries and

developing countries A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agree ...

. For example, Michael L. Bennish, an American pediatrician who works in developing countries, had been volunteering in

Bangladesh Bangladesh (}, ), officially the People's Republic of Bangladesh, is a country in South Asia. It is the eighth-most populous country in the world, with a population exceeding 165 million people in an area of . Bangladesh is among the mos ...

as a physician and had noticed a number of deaths that seemed to coincide with the distribution of the government-issued cough syrup. The government rebuffed his attempts at investigating the medication. In response, Bennish smuggled bottles of the syrup in his suitcase when returning to the United States, allowing pharmaceutical laboratories in Massachusetts to identify the poisonous

, which can appear very similar to the less dangerous

. Bennish went on to author a 1995 article in the ''

British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origina ...

'' about his experience, writing that, given the amount of medication prescribed, death tolls "must lreadybe in the tens of thousands".

Indonesia

In 2022, deaths of nearly 100 children in Indonesia, were reported to be linked to cough syrup and liquid medication. The syrup contained "unacceptable amounts" of

and

ethylene glycol Ethylene glycol ( IUPAC name: ethane-1,2-diol) is an organic compound (a vicinal diol) with the formula . It is mainly used for two purposes, as a raw material in the manufacture of polyester fibers and for antifreeze formulations. It is an odo ...

, linked to acute kidney injuries (AKI). In October, health officials reported around 200 cases of AKI in children, most of who were aged under five. Indonesia temporarily banned the sale and prescription of all syrup and liquid medicines as it was not clear if these medicines were imported or locally produced.

Panama

In May 2007, 365 deaths were reported in Panama. In Panama, the imported

came from a

Chinese Chinese can refer to: * Something related to China * Chinese people, people of Chinese nationality, citizenship, and/or ethnicity **''Zhonghua minzu'', the supra-ethnic concept of the Chinese nation ** List of ethnic groups in China, people of v ...

manufacturer. The

China Food and Drug Administration The National Medical Products Administration (NMPA, , formerly the China Food and Drug Administration, or CFDA) was founded on the basis of the former State Food and Drug Administration (SFDA). In March 2013, the former regulatory body was rebra ...

did not regard the toxic cough syrup scandal as being China's fault. The Chinese manufacturer exported the

under the name TD glycerine, but the Spanish middleman Aduanas Javier de Gracia changed the name to glycerine when he filled the customs declaration in Panama.

The Gambia

In October 2022, the WHO announced a link between four paediatric cough syrups from one Indian pharmaceutical company and the deaths of 66 children in The Gambia from kidney failure. The products (Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup, and Magrip N Cold Syrup) are believed to be contaminated with

and/or

. The products involved were manufactured by Maiden Pharmaceuticals in December 2021. This has led to Maiden Pharmaceuticals' products being banned in The Gambia; a probe by the

CDSCO The Central Drugs Standard Control Organisation (CDSCO) is India's national regulatory body for cosmetics , pharmaceuticals and medical devices. It serves a similar function to the European Medicines Agency of the European Union, the PMDA of Jap ...

and volunteers from health agencies in The Gambia going door to door in an urgent recall. In December 2022, a parliamentary committee in The Gambia recommended prosecution of the Indian company, Maiden Pharmaceuticals. It also recommended banning all products by the firm in the country.

Uzbekistan

In December 2022, Uzbekistan's health ministry said that 18 children died from renal problems and acute respiratory disease after drinking cough syrup manufactured by Indian drug maker Marion Biotech. The statement did not specify over what time period the deaths occurred. As a result, Marion Biotech, was suspended from Pharmexcil, an Indian government-linked trade group. As a result,

state security police A security agency is a governmental organization that conducts intelligence activities for the internal security of a nation. They are the domestic cousins of foreign intelligence agencies, and typically conduct counterintelligence to thwart other ...

in Uzbekistan arrested four people.

References

{{reflist 2007 in Panama 2007 health disasters Medical scandals Health in Panama Antitussives Drug safety Health disasters in North America Adulteration Mass poisoning 2022 in Indonesia 2022 in Uzbekistan 2022 health disasters 2022 in the Gambia