Medicines, contaminated

Sadly, practices and laws that should be universal (not all laws should be) do not become so. It is astonishing that following the 1938, FDA-driven outlawing of the use of diethylene glycol in medicinal formulations (see Chapter 6), several countries have reported deaths caused by medicines contaminated with diethylene glycol most recently, 88 children died in Haiti (1995/1996), 33 children died in India (1998), and more than 22 people died in Panama (2006). 

It is obvious that medicines contaminated with potentially pathogenic (disease-causing) micro-... 

In view of the likelihood for accidental and deliberate (medicinal) contamination of the eye, there is a need for... 

The use of ethyl alcohol ia some medicinal and cosmetic products requires a very meticulous grade, particularly with reference to odor. In some instances, the odor can be correlated with the concentration of certain minor impurities in most instances it caimot be direcdy associated with any measurable contaminant, and the quality can be ascertained only by odor comparison with previously accepted material. 

Calomel, Hg2Cl2, has been widely used medicinally but possible contamination by the more soluble and poisonous HgCl2 renders this a hazardous nostrum. 

Plastics are extensively used in medicine to package drugs, ointments, and accessories. Plastics serve to protect medicines, surgical/ clinical equipment, medical materials, etc. from contamination and breakage in many ways, from single-service squeeze packs of cough syrup to carrying cases used to ship human eyes between hospital eye banks. 

The recycled plastic will also have a degree of different contaminants that would eliminate its use in certain devices or products, such as in medicine, electronics, and food packaging. However, within these market applications there are acceptable designs with three-layer coextruded, coinjected, or laminated structures having the contaminated plastic as the center layer, isolated by clean plastics around it and no migration occurring. 

Many medicines contain a wide variety of ingredients, often in quite complex physicochemical states, included to create formulations which are efficacious, stable and sufficiently elegant to be acceptable to patients. Should microbial contaminants survive manufacture, or enter during storage or use they are likely to meet conditions which are often conducive to survival and even replication of an appreciable assortment of non-fastidious bacteria, ftingi and yeasts, and microbial spoilage may ensue unless steps are taken to control it. Microbial spoilage may include ... 

Microbial contaminants will usually need to be able to attack ingredients of a medicine and create substrates necessary for biosynthesis and energy production before they can replicate to levels where obvious spoilage becomes apparent since, for example, 10 microbes will have an overall degradative effect around 10 time faster than one cell. However, growth and attack may well be localized in surface moisture films or very unevenly distributed within the bulk of viscous formulations such as creams. Early... 

The indigenous microbial population is quite different in the home and in hospitals. Pathogenic organisms are found much more frequently in the latter and consequently are isolated more often from medicines used in hospital. Usually, there are fewer opportunities for contamination in the home, as patients are generally issued with individual supplies in small quantities. 

By contrast, medicines used in the home are not orrly less often eontaminated but also contain lower levels of contaminants and fewer pathogenie orgarrisms. Generally, there are fewer opportunities for contamination here since smaller quantities are used by individual patients. Medicines in the home may, however, be hoarded and used for extended periods of time. Additionally, storage conditions may be imsuitable and expiry dates ignored and thus problems other than those of microbial contamination may be seen in the home. 

The fate of contaminants ingested orally in medicines may be determined by several factors, as is seen with contaminated food. The aeidity of the stomaeh m provide a successful barrier, depending on whether the medicine is taken on an empty or flill stomach and also on the gastrie emptying time. Contaminants in topieal products m cause tittle harm when deposited on intaet skin. Not only does the skin itself provide an... 

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