Abstract
In 2019, bacterial infections resulted in 7.7 million deaths, accounting for 1 out of every 8 deaths that year. Millions of these deaths could have been prevented with adequate access to appropriate antibiotics. One such antibiotic is amoxicillin trihydrate, more commonly referred to as just amoxicillin. Amoxicillin is one of the most prescribed antibiotics and is used to treat a wide range of bacterial infections including infections of the ears, mouth, throat, nose, and lungs. The prevalence of bacterial infection related deaths and the wide range of applications for amoxicillin resulted in it being included on the World Health Organization’s (WHO) essential medicines list. Despite the demonstrated need for widespread distribution of amoxicillin, most amoxicillin productions in confined to a few nations and then imported to countries that do not produce their own antibiotics. This leaves many populations vulnerable to supply chain disruptions including Australia, which experienced supply chain disruptions in 2023, resulting in an antibiotic shortage. My technical capstone project seeks to design a manufacturing process for amoxicillin to prevent localized shortages and increase access to treatment. My STS research paper explores how cancer outcomes in rural communities in the United States differ from urban communities that typically have better access to necessary medicines, facilities, and health care professionals and the steps that are being taken to improve cancer care and accessibility in rural communities.
Technical Project:
Amoxicillin is produced by reacting 6-Aminopenicillanic Acid (6-APA) and D-Hydroxyphenylglycine Methyl Ester (HPGME) in solution in the presence of the catalyst Penicillin G Acylase (PGA). After the reaction, the pH of the solution is dropped then slowly brought back up until it reaches the point where the solution has no net charge. This point is called the isoelectric point and the product, in this case amoxicillin, will crystalize out of the solution as a solid. The solution and solid amoxicillin are then centrifuged to create a wet cake this is primarily amoxicillin with water and trace amounts of impurities. The wet cake is washed to remove impurities left over from the reaction step and subsequently dried. Finally, it is milled and combined with tableting ingredients to be capsuled and distributed across Australia.
Our group set a production goal of 80,000 kg of amoxicillin per year to approximately match the antibiotic consumption of Australia. Using this number, we designed most of the equipment needed for this process. The primary unit operations were a series of reactors, crystallizers, centrifuges, washers, dryers, a miller, and the tableting press. Additionally, we designed all ancillary equipment including pumps, tanks, and cooling systems. After an economic analysis, we determined that the plant was economically viable, and we suggested that the construction of the plant would be given the go-ahead.
STS Research Paper:
Cancer is the second leading cause of death in the United States with over 610,000 deaths annually. However, rural communities tend to have higher cancer mortality rates than urban areas. The 5-year survival rate for rural communities was about 5% lower than that in urban communities (62% for rural areas vs. 67% for metropolitan areas). In my STS paper, I found that this discrepancy is indicative of the systemic issues in rural areas that result in worse cancer survival outcomes. Some of these issues include a lack of resources in local hospitals including smaller oncologist presence, less oncology resources available including screening and treatment options, inadequate proximity to medical resources, and an increased economic burden for diagnosis and treatment. In my paper, I also explored steps that are being taken to bridge the gap and improve rural cancer treatment. Some of these programs include regionalized care as a subsection of larger networks, subsidizing drug pricing, and increasing clinical trial usage in rural hospitals.
Both my technical and STS papers highlight the importance of treatment equity in the medical setting. Inadequate access to life-saving treatment results in millions of deaths each year, so beyond the creation of the drug, the distribution of it to all people who need it must be considered. Inaccessible treatment is hardly a treatment at all and improved access, whether that be through moving production closer to the populations that need it or by understanding barriers to treatment and providing pathways to allow for greater access to care, will save lives and improve the quality of life after treatment.
