The World Health Organization has flagged at least seven cough syrups made in India as toxic in its investigation into the contaminated medicines suspected to have led to more than 300 deaths, The Indian Express reported on Tuesday.

Christian Lindmeier, the spokesperson for global health body, told the newspaper that 20 toxic products made by 15 manufacturers in India and Indonesia have been identified.

The 20 medicines are cough syrups, paracetamol and vitamins. Among these are 15 contaminated and identified syrups seven are manufactured by Haryana-based Maiden Pharmaceuticals, Noida-based Marion Biotech and Punjab-based QP Pharmachem.

Last week, the WHO had said that it was conducting an investigation into a global threat caused due to toxic cough syrups.

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India’s cough syrup testing regime has a deadly blind spot

Deaths due to toxic cough syrups made the headlines in October when the WHO issued a global alert for four such medicines manufactured by Maiden Pharmaceuticals. This was after authorities in the West African country of The Gambia linked 66 deaths – most of them due to acute kidney failure – to the four medicines.

In December, the WHO recommended not using two cough syrups made by Indian pharmaceutical firm Marion Biotech after Uzbekistan’s health ministry said that 18 children died after consuming the Dok 1 Max syrup manufactured by the company. In April, another Indian drugmaker was also found by the World Health Organization to have exported contaminated cough syrup to the Marshall Islands and Micronesia.

Last month, India said it will allow the export of cough syrups only after samples are tested at specified government laboratories.

India has zero tolerance for spurious medicines: Health minister

Commenting on allegations of deaths of children linked to India-made medicines, Union Health Minister Mansukh Mandaviya on Tuesday told PTI that India has a zero-tolerance policy on spurious medicines. He said that following reports of deaths linked to India-made cough syrups, 71 companies were issued show-cause notices and 18 of them were shut down.

“We are the pharmacy of the world and we want to assure everyone that we are the ‘quality pharmacy of the world,” the minister said.

However, Mandaviya added: “We need to get into facts whenever some questions are raised about Indian medicines. For example in Gambia, it was said that 49 children have died. Someone at WHO had said it and we wrote to them asking what the facts are. No one got back to us with the facts.”

The health minister said that in one case, a child who died was found to have diarrhoea. “If a child had diarrhoea, who recommended cough syrup for that child?” he asked.

Mandaviya added that 24 samples of the medicines were tested, of which four failed, according to PTI. “The question is if there was just one batch made for exports and if that fails, all samples would fail,” he said. “It is not possible that 20 samples are passed and four samples fail. Still, we are alert.”