Update on counterfeit antibiotics worldwide; public health risks.

Antibiotics are the most counterfeited medicines and account for 28% of global counterfeit medicines. Counterfeit antibiotics are estimated at 5% of the global antibiotic market. No area in the world seems to be spared from counterfeiting of antibiotics. However, these are rare in developed countries, whereas the strong demand for antibiotics in emerging countries creates a highly attractive market for counterfeiters. Thus, 78% of counterfeit antibiotics come from South-East Asia and their destination is mainly emerging countries (South-East Asia: 44%; sub-Saharan Africa: 30%; Europe, North America: 9%; others: 16%). Counterfeit antibiotics are antibiotics that have been commonly used for years (beta-lactams: 50%; quinolones: 12%; macrolides, lincosamides, and synergistins: 1%; cyclins: 7%; others: 20%). The main counterfeit formulations (77%) concern oral administration (tablets, syrup, capsules) whereas injected drugs account for only 17% of counterfeit formulations, and eye drops and ointments 6%. The kind of counterfeiting for antibiotics is similar to that of other drugs (no active ingredients: 43%; bad quality: 24%; insufficient quantity of active ingredients: 21%; wrong active ingredients: 7%; counterfeit packaging: 5%). Beyond the harmful effects for patients, counterfeit medicines favor the emergence of bacterial resistance with a worldwide impact. Great efforts have been made to fight global counterfeiting of medicines since 1985.