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Clinical effectiveness of co-trimoxazole versus leading antibiotics proves its cost-effectiveness, efficacy & safety

Home  >  TopNews you can get e-magazine links on WhatsApp. Click here Corporate + Font Resize Clinical effectiveness of co-trimoxazole versus leading antibiotics proves its cost-effectiveness, efficacy & safety Shardul Nautiyal, Mumbai
Monday, January 8, 2024, 08:00 Hrs  [IST] Clinical effectiveness of co-trimoxazole versus leading antibiotic molecules in the market has proven its cost-effectiveness, efficacy and safety, explains Vivek Padgaonkar, founder, Paddy Advisory Services and former director, Organisation of Pharmaceutical Producers of India (OPPI).

“It is considered as the antimicrobial agent of choice in the treatment of many diseases, minimizing the risk of vital organ involvement and relapses. It is superior or equal to many molecules that are prescribed in the country,” Padgaonkar further explains. 

Citing a study, Padgaonkar says that in India, the out of pocket expenditure constitutes 60% of total health expenditure with substantial 40% being incurred on the medicines (Ref: Report of Standing National Committee on medicine SNCM 2022). With this background, it is of paramount importance that the accessibility and availability of essential medicines be enhanced in order to reduce the financial burden.

The National List of Essential Medicines (NLEM) of the ministry of health and family welfare (MoHFW) is incorporated in the Schedule-I of the Drugs (Prices Control) Order, 2013 (DPCO, 2013). The formulations under Schedule-I of DPCO, 2013 are mentioned according to their therapeutic category. There is no separate classification of antibiotics based on the generations i.e., 3rd or 4th generation antibiotics.

However, the Section 6.2 of Schedule-I of DPCO, 2013 deals with the class, “Antibacterials”, which includes 95 formulations of 27 medicines. Out of these, ceiling prices for 74 formulations have been fixed under NLEM 2022 and 11 formulations under NLEM 2015 as on July 31, 2023 by the National Pharmaceutical Pricing Authority (NPPA).

Below are the prices of other molecules which are used as therapeutic substitutes for the bacterial infections in case of non-availability of co-trimoxazole.

As per NPPA S.O. 1499(E) March 30, 2022, amoxicillin 500 mg + clavulanic acid 125 mg tabs is Rs. 19.95, azithromycin 250 mg tabs is Rs. 11.72, cefixime 200 mg tabs is Rs. 10.66, amoxicillin 500 mg caps is Rs. 7.17, levofloxacin 250 mg tabs is Rs. 4.90, cefadroxil 500 mg tabs is Rs. 4.47, ciprofloxacin 250 mg tabs is Rs. 2.30 and co-trimoxazole (trimethoprim 80 mg) +sulfamethoxazole 400 mg) tabs is Rs. 0.86.

Antibiotic development is no longer considered to be an economically wise investment for the pharmaceutical industry. Because antibiotics are used for relatively short periods and are often curative, antibiotics are not as profitable as drugs that treat chronic conditions, such as cardiac, diabetes, psychiatric disorders, asthma, or gastroesophageal reflux. A cost–benefit analysis by the Office of Health Economics in London calculated that the net present value (NPV) of a new antibiotic is only about US$ 50 million, compared to approximately US$ 1 billion for a drug used to treat a neuromuscular disease. Because medicines for chronic conditions are more profitable, pharmaceutical companies prefer to invest in them. Over the span of 80 years, a total of 150 antibiotics have been developed. However, it is not anticipated that any new antibiotics will be introduced for a minimum of 10 years.

Because of these factors, many large pharmaceutical companies fear a potential lack of return on the investment that would be required to develop a new antibiotic. The Infectious Diseases Society of America (IDSA) reported that as of 2013, very few antibacterial compounds were in phase 2 or 3 development.