Evaluation of the price-efficacy relationship for multiple brands of ciprofloxacin and gentamicin in Kabul: a cross-sectional study.

Abstract

Background: The quality of consumer products constitutes a prominent issue on a global scale. The proliferation of counterfeit pharmaceuticals poses a significant challenge not only in developing and underdeveloped nations but also represents a considerable concern in developed countries. In Kabul, a major issue is the availability of multiple brands of antibiotics with fluctuating prices. To ascertain the quality and correlation of pricing with the efficacy of antibiotics, an evaluation of their effectiveness is deemed both essential and significant. Ciprofloxacin and Gentamicin are widely utilized antibiotics for treating infections induced by specific strains of Gram-negative and Gram-positive bacteria. The aim of this study was to investigate the relationship between brand price and the efficacy of these antibiotics.

Methods: A total of 40 ciprofloxacin 500 mg tablet brands and 15 gentamicin 80 mg ampule brands were procured from pharmacies in Kabul across eight countries. Ten samples from each brands were assessed for efficacy through MIC and MBC assays against Staphylococcus aureus (ATCC 29213), following Clinical and Laboratory Standards Institute protocols. Efficacy data were obtained by inoculating S. aureus suspensions in Mueller-Hinton medium with various concentrations of each antibiotic, incubated at 35-37˚C for 24 h. Following MIC determination, inoculated cultures were plated on Mueller-Hinton agar and incubated at 35-37˚C for 24 h for colony enumeration. Statistical analysis was conducted using ANOVA, Student's t-test, and Pearson correlation via SPSS version 26, with p-values of ≤ 0.05 considered significant.

Results: The prices of Ciprofloxacin tablets ranged from 25 to 275 Afghanis (mean = 99.60), while Gentamicin prices varied from 3 to 15 Afghanis (mean = 8.37). Of the 40 ciprofloxacin brands, 6 (15%) were unregistered, and from 15 gentamicin brands, 3 (20%) were unregistered. There was no significant difference in Gentamicin efficacy against S. aureus. However, a significant difference was noted in Ciprofloxacin efficacy against S. aureus (p < 0.01).

Conclusions: The results of this study highlight the critical need for stringent quality control and regulatory oversight, especially for unregistered antibiotics, due to the significant variations observed in Ciprofloxacin efficacy (p < 0.01), even though no such difference was noted with Gentamicin. Policymakers should implement regulations to ensure all antibiotic brands adhere to quality standards, while pharmacists and healthcare professionals should prioritize using registered, effective medications to safeguard public health.