Authorities in Uzbekistan say 18 children have died after taking a medicinal syrup manufactured by an Indian pharmaceutical company for relief of cold and flu symptoms.

The press service of the Uzbek ombudsman reported the 18 deaths this week, raising its previous report of 15 fatalities among 21 children who took the medicine Doc-1 Max.

The Health Ministry on December 28 also said 18 out of 21 children who took the syrup while suffering from an acute respiratory disease died after consuming it.

The chief physician of the Samarkand Regional Children's Multidisciplinary Medical Center said in a letter dated December 15 to the head of the regional health department that the 21 children who took Doc-1 Max "showed signs of kidney damage and kidney failure."

According to the press service of the ombudsman, the patients were from the Jizzaq, Samarkand, Navoi, and Qashqadaryo regions. All 21 children were under 6 years old; 15 of them were under 3 years old. The three children who recovered have been discharged from the hospital.

The syrup, which is manufactured by the Indian company Marion Biotech, was imported to Uzbekistan by Quramax Medical LLC, the ministry said in a statement on December 27 quoted by Reuters. A batch of the syrup contained ethylene glycol, which the Health Ministry said was a toxic substance.

Marion Biotech, Quramax Medical, and the Indian Health Ministry did not immediately respond to a Reuters request seeking comment.

When relatives of the patients were asked about the causes of their illness, they said that they had symptoms of a cold and their condition worsened after taking the medicine.

The instructions for use indicate that it can be used from the age of 2, but similar drugs from other companies are allowed to be used after 12 years, the ombudsman said.

After the incident came to light, it was announced that the sale of Doc-1 Max in Uzbekistan was temporarily suspended from December 22.

The Health Ministry also said it had dismissed seven employees for negligence for not analyzing the deaths in a timely manner and failing to take necessary measures. It said it had disciplined some other employees but didn't specify their role in the incident.

Kyrgyzstan also suspended the sale of Doc-1 Max, RFE/RL reports.