Indonesia to procure more antidotes from Singapore for patients with acute kidney injury

Paracetamol syrup for children being removed from the shelves by a pharmacist in West Java, Indonesia, on Oct 20. PHOTO: EPA-EFE

JAKARTA – Indonesia will buy more antidotes from Singapore and Australia to help reduce child deaths from acute kidney injury linked to medicinal syrups, Health Minister Budi Gunadi Sadikin said on Friday. 

The death toll rose to 133 on Friday, accounting for 55 per cent of the 241 cases of acute kidney injury among children in 22 provinces this year, according to the Health Ministry. The majority of patients were five and below.

Mr Budi said the government will procure 200 vials of Fomepizole Injection.

Earlier this week, 10 vials were hand-carried from Singapore and used to treat 10 patients at the state-run Cipto Mangunkusumo General Hospital in Jakarta. 

“After they were given this medicine, some got better while some were stable. So we feel more confident that it is effective,” Mr Budi told reporters. 

“The Indonesian government is procuring more (Fomepizole)… Hopefully, this can reduce the fatality rate.”

The minister said he had contacted his Singapore counterpart to check the availability of the antidotes, adding that the supply will be delivered as soon as possible. 

Fomepizole is used to treat ethylene glycol poisoning. Ethylene glycol and diethylene glycol are impurities that appear in polyethylene glycol, a solubility enhancer in syrups for fever, cough and flu. The metabolism of these compounds can cause significant liver and kidney damage.

Under Indonesia’s regulations pertaining to drug manufacturing, the tolerable daily intake of ethylene glycol and diethylene glycol is 0.5mg per kilogramme of body weight a day.

According to Singapore’s Health Sciences Authority (HSA), ethylene glycol and diethylene glycol are toxic chemicals.

Ethylene glycol and diethylene glycol were also found in the four Indian-made cough syrups that caused the deaths of nearly 70 children in Gambia. The syrups are not sold in Indonesia.

On Thursday, the country’s Food and Drug Monitoring Agency (BPOM) ordered three drug manufacturers to withdraw five brands of locally made fever, cough and flu syrups from circulation and destroy the stocks. This came after the agency found that the medicines contained ethylene glycol in an amount “that exceeds the safe limit”, it said in a statement.

A day earlier, the Health Ministry temporarily banned the sale of all syrup-based medications while an investigation is under way.

The country has formed an expert team comprising paediatricians, BPOM officials, epidemiologists and pathologists to investigate the cases, while the Health Ministry has been in touch with experts from the World Health Organisation tackling similar cases in Gambia.

The BPOM said on Thursday that there was no conclusive link between the syrups and the kidney injuries, but on Friday, Mr Budi said that the link is more certain than before.

He added that the patients in Indonesia had consumed a total of 102 syrup-based medications. 

“These medications will be temporarily banned for prescription and sales,” he said, adding that others might also be added to the list later. 

A Straits Times check at two well-known pharmacies in Jakarta found that the cough syrups have been removed from the shelves. Only cough tablets, such as Limoxin, and herbal medications are being sold.

Note: This story has been updated to clarify that Indonesia regulations allow for a tolerable daily intake of ethylene glycol and diethylene glycol. In Singapore, however, these ingredients are classified as toxic chemicals.

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