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Cough syrups linked to death
On October 5, 2022, the WHO issued an alert (No. 6/2022) on pediatric medicines of substandard quality. These are four syrups to treat coughs and colds in children. A second alert (No. 7/2022) of pedia-tric medicines was issued on November 2 for eight products such as cough syrups and acetaminophen drops. In both cases, laboratory tests on the syrups confirmed the presence of unacceptable amounts of diethylene glycol (DEG) and ethylene glycol (EG).
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The drugs mentioned in the alerts have been associated with the deaths of at least 70 children in Gambia, Africa, mostly under 5 years of age, 18 children in Uzbekistan and 199 children aged 7 to 11 years in Indonesia [1,2], in most cases acute renal insufficiencies occurred. Many of these syrups contain Paracetamol (acetaminophen) as an active ingredient, which contributes to the treatment of pain, fever and general malaise, however, this compound is poorly soluble in water and requires solvents such as glycerol or propylene glycol to provide the liquid base; some manufacturers choose to replace glycerol with compounds such as diethylene glycol (DEG) or ethylene glycol (EG), both of which tend to be cheaper.
DEG and EG are organic compounds miscible in water with a sweet taste and commonly used as industrial solvents and in the manufacture of antifreeze, dyes and brake fluids. DEG is metabolized to insoluble oxalic acid, and EG to glycoaldehyde, glycolate, glyoxylate, and oxalate. The accumulation of the resulting compounds in the body induces kidney damage and failure, cardiopulmonary problems and often death. This type of episode has continued to be recorded since 1937 (sulfanilamide Elixir) [3], so control must be increased in the proper development of new products considering Good Manufacturing Practices, and above all taking care of the health of the population.
Dr. Claudia Mejía Morales
Research and Development Analyst at Drox Health Science. PhD in Innovation in Medical and Pharmaceutical Biotechnology. Master in Molecular Biology.
