MP: Coldrif cough syrup fatality count rises to 24 after two more children die

The death toll in the adulterated cough syrup tragedy has climbed to 24, after two more children from Madhya Pradesh’s Chhindwara district died of suspected renal failure while undergoing treatment in Nagpur, Maharashtra, officials confirmed on Wednesday.

The latest victims have been identified as nine-month-old Divyanshu Yaduwanshi and three-year-old Ambika Vishwakarma, both from Chhindwara. Additional collector Dhirendra Singh said Divyanshu, a resident of Parasia town, died on Sunday, while Ambika, from Kakai Bohana, succumbed late on Tuesday after battling for her life for nearly a month.

“Ambika was admitted to New Health City Hospital in Nagpur in critical condition on 14 September. Her health did not improve despite treatment and she passed away on Tuesday night,” Singh said. Two other children remain under treatment in the city, he added.

Most of the victims — all below five years of age — had reportedly developed acute kidney failure after being administered the cough syrup Coldrif, manufactured by Sresan Pharmaceutical Manufacturer, a Tamil Nadu-based company.

The Chhindwara deaths are part of a growing list of cases linked to contaminated paediatric syrups in India. At least three children in Rajasthan have also allegedly died after consuming similar formulations in recent weeks, prompting nationwide concern and an international alert from the World Health Organization (WHO).

On 8 October, WHO issued a warning against three “substandard” oral cough syrups — Coldrif, Respifresh TR, and ReLife — after tests found dangerously high levels of diethylene glycol (DEG), a toxic industrial solvent used in antifreeze and brake fluid. The substance is lethal even in small quantities, capable of causing severe kidney and liver damage, neurological disorders, and death, particularly in children.

The WHO alert marked the latest in a disturbing series of Indian cough syrup scandals that have drawn global scrutiny. Similar DEG-linked mass poisonings have previously been reported in The Gambia (2022), Uzbekistan (2022), and Cameroon (2023), all traced to Indian-manufactured syrups.

An investigation by the Tamil Nadu Drugs Control Directorate on 2 October found that samples of Coldrif failed quality standards, declaring them “not of standard quality”. A subsequent analysis by Madhya Pradesh authorities revealed that one sample contained 48.6 per cent diethylene glycol, nearly 500 times the permissible limit of 0.1 per cent as an impurity.

Following these findings, state governments across the country — including Tamil Nadu, Madhya Pradesh, Kerala, Karnataka, Punjab, Himachal Pradesh, Uttar Pradesh, Puducherry, West Bengal, and Delhi — have banned the sale and distribution of Coldrif.

The Madhya Pradesh Police have arrested Dr Praveen Soni, a Chhindwara-based practitioner accused of negligence in prescribing the tainted syrup. Meanwhile, a Special Investigation Team (SIT) from Madhya Pradesh tracked down and arrested Sresan Pharma owner G. Ranganathan from Tamil Nadu on 9 October.

In response to mounting outrage, the Tamil Nadu government announced on Monday that it has revoked Sresan Pharma’s manufacturing licence and ordered the immediate closure of the facility.

The episode has once again exposed regulatory weaknesses in India’s pharmaceutical oversight, particularly in the testing and approval of small-scale drug manufacturers. Although India is one of the world’s largest producers of generic medicines, the country’s fragmented state-level regulatory system often allows substandard formulations to slip through safety nets.

Public health experts point out that the toxic adulteration of syrups is not a new phenomenon. The first documented DEG poisoning in India dates back to 1972, in Chennai, and since then, at least half a dozen mass poisoning incidents have been reported, the deadliest being the 1998 Haryana tragedy, where more than 30 children died after consuming a contaminated cough syrup.

Despite repeated government assurances, experts say enforcement remains reactive rather than preventive. “The pattern is disturbingly familiar — deaths occur, tests confirm contamination, and only then does regulatory action follow,” said a senior pharmacologist at a Delhi teaching hospital. “The tragedy is that these deaths are entirely preventable.”

The Union Health Ministry has directed all state drug controllers to step up surveillance and random testing of paediatric formulations. Officials have also asked the Central Drugs Standard Control Organisation (CDSCO) to conduct a nationwide audit of syrup manufacturers, especially smaller firms operating without WHO-GMP (Good Manufacturing Practices) certification.

Meanwhile, Opposition leaders have accused the Modi government of allowing lax regulation and fragmented quality control to persist despite multiple international embarrassments. “India’s pharma reputation has been built over decades, and incidents like these are eroding trust,” said a Congress spokesperson, urging the Centre to introduce a unified national testing protocol for all liquid medicines before export or domestic sale.

This latest tragedy adds to the growing list of global alerts involving Indian-made medicines in recent years. The WHO had previously linked Marion Biotech’s Dok-1 Max and Maiden Pharmaceuticals’ cough syrups to child deaths in Uzbekistan and The Gambia respectively, prompting bans, factory closures, and international criticism of India’s regulatory system.

Health policy analysts warn that unless systemic reforms are undertaken — including regular quality audits, centralised licensing, and mandatory DEG testing — such incidents could undermine India’s position as the “pharmacy of the world”.

For the families in Chhindwara, however, these failures translate to an unbearable loss. “We trusted what the doctor prescribed,” said a grieving relative of one of the victims. “We never imagined a medicine meant to cure a cough could take a life.”

With PTI inputs