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Gross AE, Kabbani S, Blumenthal J. The perfect storm: respiratory viral surges and anti-infective shortages. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e89. [PMID: 37179757 PMCID: PMC10173286 DOI: 10.1017/ash.2023.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Alan E. Gross
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
- Hospital Pharmacy Services, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
- Corresponding author: Alan E. Gross, PharmD, FCCP, BCIDP, BCPS, Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, 833 South Wood Street, Suite 164, Chicago, IL60612.
| | - Sarah Kabbani
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Blumenthal
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
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Part I: Interactive case: Management of urgent drug shortages. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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3
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SHEA statement on antibiotic stewardship in hospitals during public health emergencies. Infect Control Hosp Epidemiol 2022; 43:1541-1552. [PMID: 36102000 PMCID: PMC9672827 DOI: 10.1017/ice.2022.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Thomas CM, Peterson J, Ahiskali A, Hamid L, Butts J, Czachura J, Alpern JD. Hospital pharmacy acquisition of nonstocked antimicrobials-current processes and areas for improvement. J Am Pharm Assoc (2003) 2022; 62:1848-1854. [PMID: 36068143 PMCID: PMC9637775 DOI: 10.1016/j.japh.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The delivery of prompt and appropriate antimicrobial therapy for life-threatening infections is an important antimicrobial stewardship measure and a priority for hospitals. OBJECTIVES To better understand U.S. hospital pharmacy stocking processes and acquisition of nonstocked antimicrobials and to identify strategies for improving this process. METHODS This mixed-methods study recruited infectious diseases and antimicrobial stewardship pharmacists. Semistructured interviews with pharmacists in Minnesota were conducted via video conferencing software from January 21, 2021, to March 17, 2021. Audio recordings of the interviews guided survey development and were also transcribed, coded, and qualitatively analyzed. Surveys were distributed throughout the United States via an e-mail listserv, and responses were collected between August 5, 2021, and September 15, 2021. RESULTS Ten interviews and 78 surveys were included in the analysis. Formulary and stocking practices varied based on institution. Stocking decisions were most frequently based on the frequency of use, clinical utility, and cost of antimicrobials. Nonstocked antimicrobials were often ordered from the wholesale distributor but, if needed urgently, acquired from another local institution. Antibacterial agents were the most frequently needed nonstocked antimicrobials, especially those targeting multidrug-resistant gram-negative bacteria. When acquiring nonstocked antimicrobials, barriers include process inefficiencies, cost, availability, and safety concerns. Improved information sharing between local institutions may help improve this process. CONCLUSION In this exploratory study, antimicrobial stocking practices varied within U.S. hospitals. Acquisition of nonstocked, urgently needed antimicrobials from neighboring hospitals may be common; however, this process lacks guidance and is often inefficient. Establishing better mechanisms for information sharing may improve this process and should be explored.
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Affiliation(s)
- Christine M. Thomas
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN
| | | | | | - Lina Hamid
- M Health Fairview, University of Minnesota Medical Center, Minneapolis, MN
| | - Jessica Butts
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Jennifer Czachura
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Jonathan D. Alpern
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN; and Clinical Research Investigator, HealthPartners Institute, Bloomington, MN
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Miljković N, Polidori P, Kohl S. Managing antibiotic shortages: lessons from EAHP and ECDC surveys. Eur J Hosp Pharm 2022; 29:90-94. [PMID: 35190453 PMCID: PMC8899686 DOI: 10.1136/ejhpharm-2021-003110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVE To compare antibiotic shortages in Europe between 2013 and 2020 and the views of hospital pharmacists on overcoming shortages via antimicrobial stewardship. METHODS A series of European Association of Hospital Pharmacists (EAHP) surveys on medicine shortages, including a survey on the future crisis preparedness of hospital pharmacies, conducted between 2013 and 2020 were compared for the type of antibiotic shortages and respective mitigation strategy. These were analysed taking into account hospital pharmacists' views on antibiotics provided in the European Centre for Disease Prevention and Control (ECDC) survey on healthcare professionals' knowledge, attitudes and behaviours about antibiotics, antibiotic use and antibiotic resistance from 2018. RESULTS Since 2013 there has frequently been a shortage of antibiotics in European hospitals. In 2014, 67% (347/521) of hospital pharmacists experienced shortages of antimicrobials compared with 77% (1032/1348) in 2018, 63% (1158/1837) in 2019 and 37% (539/1466) in 2020. More than 80% of hospital pharmacists managed antibiotic shortages through substitution in 2014 (284/336) and 2018 (786/946), while this percentage was 40% (63/158) and 42% (620/1466) in 2019 and 2020, respectively. Although 72% (870/1204) of hospital pharmacists received information on how to avoid inappropriate antibiotic prescribing, dispensing and administration, only 37% (450/1204) changed their views and 28% (338/1204) changed their practice in steering antimicrobial treatment. CONCLUSION Antibiotic shortages affect proper antimicrobial stewardship because of limited appropriate alternatives, taking into account patients' clinical condition and type of infection. While substitution remains a leading mitigating tool for antibiotic shortages, it carries numerous risks and the potential for antimicrobial resistance and suboptimal health outcomes.
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Affiliation(s)
- Nenad Miljković
- Hospital Pharmacy, Institute of Orthopaedics Banjica, Belgrade, Serbia
| | - Piera Polidori
- Hospital Pharmacy, United Villa Solfia-Cervello Hospitals, Palermo, Sicily, Italy
| | - Stephanie Kohl
- Policy & Advocacy, European Association of Hospital Pharmacists, Brussels, Belgium
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Miljković N, Batista A, Polidori P, Kohl S, Horák P. Results of EAHP's 2019 Medicines Shortages Survey. Eur J Hosp Pharm 2020; 27:202-208. [PMID: 32471816 DOI: 10.1136/ejhpharm-2020-002341] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVES The aim of the 2019 EAHP Medicines Shortages Survey was to collect information on reasons and management strategies for medicines shortages as well as details on their impact on patients. The survey targeted hospital pharmacists (HPs), physicians (PHYs), nurses (NRS) and other healthcare professionals (OHCPs). A separate set of questions addressed patients (PTNs). METHODS A 28-question survey was conducted by EAHP, collecting information from European HPs, PTNs, NRS, PHYs and OHCPs on the shortage situation in their respective countries. The survey ran from 7 November 2019 to 13 January 2020. The results were analysed by EAHP. RESULTS There were 2136 HP responses to the 2019 survey compared with 1666 in 2018. While 95% of HPs and 89% of OHCPs consider medicine shortages a current problem, only 71% of PHYs and 62% of NRS state the same. Shortages of active pharmaceutical ingredients (72%), manufacturing (72%) and supply chain problems (49%) are leading causes of shortages according to HPs, while PHYs (40%) and NRS (37%) consider the pricing to be their driver. Antimicrobials and oncology medicines were most affected by shortages in 2019. Compared to 2018, the percentage of respondents who reported shortages of oncology medicines increased from 39% to 47% in 2019. HPs (42%), PHYs (36%) and OHCPs (38%) consider delays in care as the main consequence of medication shortages. The satisfaction with reporting systems for medicine shortages decreased from 56% in 2018 to 48% in 2019 for HPs, while they remain low for PHYs (36%). CONCLUSIONS Medicines shortages affect patient care and healthcare professionals' everyday tasks. Better enforcing of the mandatory early notification of shortages and structured mitigation response is recognised by all respondents as best strategy to tackle shortages.
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Affiliation(s)
- Nenad Miljković
- Hospital Pharmacy, Institute of Orthopaedic Surgery 'Banjica', Belgrade, Serbia
| | - Aida Batista
- Pharmacy, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - Piera Polidori
- Hospital Pharmacy, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Stephanie Kohl
- Policy & Advocacy, European Association of Hospital Pharmacists, Brussels, Belgium
| | - Petr Horák
- Hospital Pharmacy, Motol University Hospital, Praha, Czech Republic
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Miljković N, Godman B, van Overbeeke E, Kovačević M, Tsiakitzis K, Apatsidou A, Nikopoulou A, Yubero CG, Portillo Horcajada L, Stemer G, Kuruc-Poje D, De Rijdt T, Bochenek T, Huys I, Miljković B. Risks in Antibiotic Substitution Following Medicine Shortage: A Health-Care Failure Mode and Effect Analysis of Six European Hospitals. Front Med (Lausanne) 2020; 7:157. [PMID: 32478082 PMCID: PMC7235345 DOI: 10.3389/fmed.2020.00157] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/08/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction: Medicine shortages result in great risk for the continuity of patient care especially for antimicrobial treatment, potentially enhancing resistance rates and having a higher economic impact. This study aims to identify, describe, assess, and assign risk priority levels to potential failures following substitution of antimicrobial treatment due to shortages among European hospitals. Furthermore, the study investigated the impact of corrective actions on risk reduction so as to provide guidance and improve future patient care. Methods: Health-care failure mode and effect analysis (HFMEA) was applied to hospitals in Austria (H-AT), Belgium (H-BE), Croatia (H-CR), Greece (H-GR), Spain (H-SP), and Serbia (H-SR). Multidisciplinary teams identified processes, failure modes, causes, and corrective actions related to antibiotic substitution following medicine shortages. Characteristics of study hospitals as well as severity, probability, and hazard scores (HSs) of failure modes/causes were analyzed using Microsoft Office Excel 2010 and IBM SPSS Statistics® via descriptive and inferential statistics. Results: Through HFMEA, 74 failure modes were identified, with 53 of these scoring 8 or above on the basis of assigned severity and probability for a failure. Severity of failure modes differed before and after corrective actions in H-CR, H-GR, and H-SR (p < 0.005). Their probability differed in all study hospitals (p < 0.005) when compared before and after corrective actions aimed to be implemented. The highest number of failure-mode causes was detected in H-CR (46) and the lowest in H-SP (16). Corrective actions can address failure modes and lower HSs; therein, all teams proposed the following: structuring communication among stakeholders, introducing electronic prescribing, strengthening pharmacists' involvement, and increasing effectiveness of the ward stock assessment. These proposed actions led to HS reductions up to 83%. Conclusion: There is a lack of structure in addressing risks associated with antibiotic substitution following shortages. Furthermore, lack of communication, data scarcity on availability of antibiotics, non-supportive information technology (IT) systems, and lack of internal substitution protocols hinder quick assessment of alternatives addressing patient needs. Nevertheless, the study shows that health-care professionals manage to secure optimal antimicrobial treatment for patients using available IT and human resources.
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Affiliation(s)
- Nenad Miljković
- Institute for Orthopaedic Surgery "Banjica", University of Belgrade, Belgrade, Serbia
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom.,Department of Public Health and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Milena Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Karyofyllis Tsiakitzis
- General Hospital of Thessaloniki "G. Papanikolaou", Hospital Pharmacy Department, Thessaloniki, Greece
| | - Athina Apatsidou
- General Hospital of Thessaloniki "G. Papanikolaou", Hospital Pharmacy Department, Thessaloniki, Greece
| | - Anna Nikopoulou
- General Hospital of Thessaloniki "G. Papanikolaou", Hospital Pharmacy Department, Thessaloniki, Greece
| | | | | | - Gunar Stemer
- Gunar Stemer, Medicines Information and Clinical Pharmacy Services, Vienna General Hospital, Vienna, Austria
| | - Darija Kuruc-Poje
- General Hospital "Dr. Tomislav Bardek", Hospital Pharmacy Department, Koprivnica, Croatia
| | - Thomas De Rijdt
- Pharmacy Department, University Hospitals Leuven, UZ Herestraat, Leuven, Belgium
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
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Gross AE, MacDougall C. Roles of the clinical pharmacist during the COVID-19 pandemic. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1231] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Alan E. Gross
- Hospital Pharmacy Services; University of Illinois Hospital and Health Sciences System; Chicago Illinois USA
- Department of Pharmacy Practice; University of Illinois at Chicago College of Pharmacy; Chicago Illinois USA
| | - Conan MacDougall
- Department of Clinical Pharmacy; University of California San Francisco School of Pharmacy; San Francisco California USA
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Castan B, Gauzit R, Tattevin P. Gestion des pénuries d’antibiotiques en réanimation. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Gross AE, Johannes RS, Gupta V, Tabak YP, Srinivasan A, Bleasdale SC. The Effect of a Piperacillin/Tazobactam Shortage on Antimicrobial Prescribing and Clostridium difficile Risk in 88 US Medical Centers. Clin Infect Dis 2018; 65:613-618. [PMID: 28444166 DOI: 10.1093/cid/cix379] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/20/2017] [Indexed: 12/14/2022] Open
Abstract
Background Anti-infective shortages are a pervasive problem in the United States. The objective of this study was to identify any associations between changes in prescribing of antibiotics that have a high risk for CDI during a piperacillin/tazobactam (PIP/TAZO) shortage and hospital-onset Clostridium difficile infection (HO-CDI) risk in 88 US medical centers. Methods We analyzed electronically captured microbiology and antibiotic use data from a network of US hospitals from July 2014 through June 2016. The primary outcome was HO-CDI rate and the secondary outcome was changes in antibiotic usage. We fit a Poisson model to estimate the risk of HO-CDI associated with PIP/TAZO shortage that were associated with increased high-risk antibiotic use while controlling for hospital characteristics. Results A total of 88 hospitals experienced PIP/TAZO shortage and 72 of them experienced a shift toward increased use of high-risk antibiotics during the shortage period. The adjusted relative risk (RR) of HO-CDI for hospitals experiencing a PIP/TAZO shortage was 1.03 (95% confidence interval [CI], .85-1.26; P = .73). The adjusted RR of HO-CDI for hospitals that both experienced a shortage and also showed a shift toward increased use of high-risk antibiotics was 1.30 (95% CI, 1.03-1.64; P < .05). Conclusions Hospitals that experienced a PIP/TAZO shortage and responded to that shortage by shifting antibiotic usage toward antibiotics traditionally known to place patients at greater risk for CDI experienced greater HO-CDI rates; this highlights an important adverse effect of the PIP/TAZO shortage and the importance of antibiotic stewardship when mitigating drug shortages.
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Affiliation(s)
- Alan E Gross
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago.,Hospital Pharmacy Services, University of Illinois Hospital and Health Sciences System, Chicago
| | - Richard S Johannes
- Becton, Dickinson and Company, Franklin Lakes, New Jersey.,Division of Gastroenterology, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
| | - Ying P Tabak
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
| | - Arjun Srinivasan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention,Atlanta, Georgia
| | - Susan C Bleasdale
- Internal Medicine, Division of Infectious Diseases, University of Illinois at Chicago
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Rhodes NJ, Gilbert EM, Skoglund E, Esterly JS, Postelnick MJ, McLaughlin MM. Prediction of inventory sustainability during a drug shortage. Am J Health Syst Pharm 2017; 73:1094-8. [PMID: 27385704 DOI: 10.2146/ajhp150532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A methodology for predicting how long the on-hand inventory of a given medication will last during a supply shortage is described; a practical example of application of the methodology is provided. METHODS Single-site data on consumption of i.v. tobramycin over an eight-month evaluation period were collected using commercial software that tabulates barcode-assisted medication administration (BCMA) events; administered doses were standardized as 1200-mg "vial-equivalents" and summed over the review period. The total number of vial-equivalents consumed was divided by the number of "non-zero weeks of consumption" (i.e., weeks during which any tobramycin use occurred) to obtain a mean ± S.D. weekly consumption rate; this rate was multiplied by the total i.v. tobramycin on-hand supply (in vial-equivalents) to determine the mean number of potentially sustainable weeks of therapy in the event a shortage were to restrict the future supply of the drug. RESULTS Overall, 99.6 vial-equivalents of i.v. tobramycin were used during the evaluation period. The mean ± S.D. number of vial-equivalents used per non-zero week of consumption was 3.11 ± 1.26. A manual count of pharmacy inventory revealed that 102.9 vial-equivalents were available at the time of analysis. The mean predicted duration of supply was 33 weeks (95% confidence interval, -126 to 192 weeks). CONCLUSION Available BCMA data on tobramycin consumption over eight months were used to calculate the mean number of weeks the on-hand supply of the drug could be expected to last during a persistent drug shortage.
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Affiliation(s)
- Nathaniel J Rhodes
- Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, ILDepartment of Pharmacy, Northwestern Memorial Hospital, Chicago, IL
| | - Elise M Gilbert
- Department of Pharmacy Practice, Chicago State University College of Pharmacy, Chicago, ILDepartment of Pharmacy, Northwestern Memorial Hospital, Chicago, IL
| | | | - John S Esterly
- Department of Pharmacy Practice, Chicago State University College of Pharmacy, Chicago, ILDepartment of Pharmacy, Northwestern Memorial Hospital, Chicago, IL
| | | | - Milena M McLaughlin
- Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, ILDepartment of Pharmacy, Northwestern Memorial Hospital, Chicago, IL.
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Drug shortages and patient safety: an overview of essential information for the infusion nurse. JOURNAL OF INFUSION NURSING 2016; 38:205-8. [PMID: 25871867 DOI: 10.1097/nan.0000000000000101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Drug shortages present a growing problem in the United States, with the majority of shortages occurring among sterile injectable medications. Although the impact of shortages has been shown to adversely affect patient care in a variety of settings, those who are dependent on outpatient or home infusion therapy are especially vulnerable. Legislative action and the efforts of the U.S. Food and Drug Administration have helped reduce the occurrence of new shortages; however, the problem is not likely to be eliminated in the short term and requires effective management strategies.
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Effective Antibiotic Conservation by Emergency Antimicrobial Stewardship During a Drug Shortage. Infect Control Hosp Epidemiol 2016; 38:356-359. [PMID: 27917734 DOI: 10.1017/ice.2016.289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present the first description of an antimicrobial stewardship program (ASP) used to successfully manage a multi-antimicrobial drug shortage. Without resorting to formulary restriction, meropenem utilization decreased by 69% and piperacillin-tazobactam by 73%. During the shortage period, hospital mortality decreased (P=.03), while hospital length of stay remained unchanged. Infect Control Hosp Epidemiol 2017;38:356-359.
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Paskovaty A, Lucarelli CD, Patel P, Ryan M, Seyboth B, Thackray J, Pozotrigo M, Orsini N, Seo SK. Antimicrobial stewardship efforts to manage a pentamidine shortage. Am J Health Syst Pharm 2015; 71:2014-8. [PMID: 25404592 DOI: 10.2146/ajhp130661] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Priti Patel
- Memorial Sloan Kettering Cancer CenterNew York, NY
| | - Marie Ryan
- Memorial Sloan Kettering Cancer CenterNew York, NY
| | | | | | | | - Nina Orsini
- Memorial Sloan Kettering Cancer CenterNew York, NY
| | - Susan K Seo
- Memorial Sloan Kettering Cancer CenterAssociate Professor of Clinical MedicineWeill Medical College of Cornell UniversityNew York, NY
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15
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McLaughlin MM, Pentoney Z, Skoglund E, Scheetz MH. Projections for antiinfective drug shortages and time to actual resolution. Am J Health Syst Pharm 2015; 71:2074-8. [PMID: 25404600 DOI: 10.2146/ajhp140116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The results of a national study of projected versus actual times to resolution of temporary U.S. shortages of antiinfective drugs are presented. METHODS Descriptive data on antiinfective drug shortages, including differences between manufacturer-estimated and actual times to shortage resolution, were collected over a one-year period via regular monitoring of the websites of ASHP and the Food and Drug Administration. Inventory data from one large hospital in the Midwest were collected in order to characterize realized shortages (i.e., those for which mitigation was required). RESULTS During the study period, there were 47 transient shortages of antiinfective medications involving 381 unique products or formulations, of which 40% (n = 19) were emergent shortages. Generic-only and brand-only medications accounted for 53% (n = 25) and 21% (n = 10) of the evaluated shortages, respectively; the median shortage duration was 40 days (interquartile range [IQR], 22-91 days). The reasons for shortages most frequently cited by manufacturers were product or formulation discontinuation (21%), increased demand (12%), and raw material shortfalls (8%). Some shortages were resolved sooner than originally projected, but overall, actual shortage durations exceeded manufacturer-projected durations by a median of 17 days (IQR, 0-52.5 days). Ten realized shortages occurred at the hospital study site, compelling the antimicrobial stewardship team to recommend alternative therapies or restrict the use of drugs in short supply. CONCLUSION The actual durations of evaluated antiinfective drug shortages during the study period were longer than the manufacturer-projected durations by a median of 17 days.
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Affiliation(s)
- Milena M McLaughlin
- Milena M. McLaughlin, Pharm.D., is Assistant Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Infectious Diseases Pharmacist, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL. Zachary Pentoney, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Northwestern Memorial Hospital; at the time of writing, he was a Pharm.D. student, Midwestern University Chicago College of Pharmacy. Erik Skoglund, B.S., is a Pharm.D. student, Midwestern University Chicago College of Pharmacy. Marc H. Scheetz, Pharm.D., M.Sc., is Associate Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, and Infectious Diseases Pharmacist, Department of Pharmacy, Northwestern Memorial Hospital
| | - Zachary Pentoney
- Milena M. McLaughlin, Pharm.D., is Assistant Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Infectious Diseases Pharmacist, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL. Zachary Pentoney, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Northwestern Memorial Hospital; at the time of writing, he was a Pharm.D. student, Midwestern University Chicago College of Pharmacy. Erik Skoglund, B.S., is a Pharm.D. student, Midwestern University Chicago College of Pharmacy. Marc H. Scheetz, Pharm.D., M.Sc., is Associate Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, and Infectious Diseases Pharmacist, Department of Pharmacy, Northwestern Memorial Hospital
| | - Erik Skoglund
- Milena M. McLaughlin, Pharm.D., is Assistant Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Infectious Diseases Pharmacist, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL. Zachary Pentoney, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Northwestern Memorial Hospital; at the time of writing, he was a Pharm.D. student, Midwestern University Chicago College of Pharmacy. Erik Skoglund, B.S., is a Pharm.D. student, Midwestern University Chicago College of Pharmacy. Marc H. Scheetz, Pharm.D., M.Sc., is Associate Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, and Infectious Diseases Pharmacist, Department of Pharmacy, Northwestern Memorial Hospital
| | - Marc H Scheetz
- Milena M. McLaughlin, Pharm.D., is Assistant Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Infectious Diseases Pharmacist, Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL. Zachary Pentoney, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Northwestern Memorial Hospital; at the time of writing, he was a Pharm.D. student, Midwestern University Chicago College of Pharmacy. Erik Skoglund, B.S., is a Pharm.D. student, Midwestern University Chicago College of Pharmacy. Marc H. Scheetz, Pharm.D., M.Sc., is Associate Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, and Infectious Diseases Pharmacist, Department of Pharmacy, Northwestern Memorial Hospital.
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Quadri F, Mazer-Amirshahi M, Fox ER, Hawley KL, Pines JM, Zocchi MS, May L. Antibacterial Drug Shortages From 2001 to 2013: Implications for Clinical Practice. Clin Infect Dis 2015; 60:1737-42. [DOI: 10.1093/cid/civ201] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/05/2015] [Indexed: 01/02/2023] Open
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Tosh PK, Feldman H, Christian MD, Devereaux AV, Kissoon N, Dichter JR. Business and continuity of operations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2015; 146:e103S-17S. [PMID: 25144857 DOI: 10.1378/chest.14-0739] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND During disasters, supply chain vulnerabilities, such as power, transportation, and communication, may affect the delivery of medications and medical supplies and hamper the ability to deliver critical care services. Disasters also have the potential to disrupt information technology (IT) in health-care systems, resulting in interruptions in patient care, particularly critical care, and other health-care business functions. The suggestions in this article are important for all of those involved in a large-scale pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS The Business and Continuity of Operations Panel followed the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology in developing key questions regarding medication and supply shortages and the impact disasters may have on healthcare IT. Task force members met in person to develop the 13 key questions believed to be most relevant for Business and Continuity of Operations. A systematic literature review was then performed for relevant articles and documents, reports, and gray literature reported since 2007. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS Eighteen suggestions addressing mitigation strategies for supply chain vulnerabilities including medications and IT were generated. Suggestions offered to hospitals and health system leadership regarding medication and supply shortages include: (1) purchase key medications and supplies from more than one supplier, (2) substituted medications or supplies should ideally be similar to those already used by an institution's providers, (3) inventories should be tracked electronically to monitor medication/supply levels, (4) consider higher inventories of medications and supplies known or projected to be in short supply, (5) institute alternate use protocols when a (potential) shortage is identified, and 6) support government and nongovernmental organizations in efforts to address supply chain vulnerability. Health-care IT can be damaged in a disaster, and hospitals and health system leadership should have plans for urgently reestablishing local area networks. Planning should include using portable technology, plans for providing power, maintenance of a patient database that can accompany each patient, and protection of patient privacy. Additionally, long-term planning should include prioritizing servers and memory disk drives and possibly increasing inventory of critical IT supplies in preparedness planning. CONCLUSIONS The provision of care to the critically ill or injured during a pandemic or disaster is dependent on key processes, such as the supply chain, and infrastructure, such as IT systems. Hospitals and health systems will help minimize the impact of medication and supply shortages with a focused strategy using the steps suggested. IT preparedness for maintaining local area networks, functioning clinical information systems, and adequate server and memory storage capacity will greatly enhance preparedness for hospital and health system clinical and business operations.
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Luans C, Cardiet I, Rogé P, Baslé B, Le Corre P, Revest M, Michelet C, Tattevin P. Causes and consequences of anti-infective drug stock-outs. Med Mal Infect 2014; 44:470-7. [PMID: 25282606 DOI: 10.1016/j.medmal.2014.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/19/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Abstract
Anti-infective drugs stock-outs are increasingly frequent, and this is unlikely to change. There are numerous causes for this, mostly related to parameters difficult to control: i) 60 to 80% of raw material or components are produced outside of Europe (compared to 20% 30 years ago), with subsequent loss of independence for their procurement; ii) the economic crisis drives the pharmaceutical companies to stop producing drugs of limited profitability (even among important drugs); iii) the enforcement of regulatory requirements and quality control procedures result in an increasing number of drugs being blocked during production. The therapeutic class most affected by drug stock-outs is that of anti-infective drugs, especially injectable ones, and many therapeutic dead ends have recently occurred. We provide an update on this issue, and suggest 2 major actions for improvement: i) to implement a group dedicated to anticipating drug stock-outs within the anti-infective committee in each health care center, with the objectives of organizing and coordinating the response whenever a drug stock-out is deemed at risk (i.e., contingency plans, substitution, communication to prescribers); ii) a national reflection lead by scientific societies, in collaboration with government agencies, upstream of the most problematic drug stock-outs, to elaborate and disseminate consensus guidelines for the management of these stock-outs.
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Affiliation(s)
- C Luans
- Service de Pharmacie, CHU Pontchaillou, 35033 Rennes Cedex, France
| | - I Cardiet
- COMEDIMS, CHU Pontchaillou, 35033 Rennes Cedex, France
| | - P Rogé
- Service de Pharmacie, CHU Pontchaillou, 35033 Rennes Cedex, France
| | - B Baslé
- Service de Pharmacie, CHU Pontchaillou, 35033 Rennes Cedex, France
| | - P Le Corre
- Service de Pharmacie, CHU Pontchaillou, 35033 Rennes Cedex, France
| | - M Revest
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Pontchaillou, 35033 Rennes Cedex, France; CIC-Inserm 0203, Faculté de Médecine, Université Rennes 1, IFR140, 35000 Rennes, France; Inserm U835, Faculté de Médecine, Université Rennes 1, IFR140, 35000 Rennes, France
| | - C Michelet
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Pontchaillou, 35033 Rennes Cedex, France; CIC-Inserm 0203, Faculté de Médecine, Université Rennes 1, IFR140, 35000 Rennes, France
| | - P Tattevin
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Pontchaillou, 35033 Rennes Cedex, France; CIC-Inserm 0203, Faculté de Médecine, Université Rennes 1, IFR140, 35000 Rennes, France; Inserm U835, Faculté de Médecine, Université Rennes 1, IFR140, 35000 Rennes, France.
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McLaughlin MM, Skoglund E, Pentoney Z, Scheetz MH. Developing a Method for Reporting Patient Harm Due to Antimicrobial Shortages. Infect Dis Ther 2014; 3:349-55. [PMID: 25234281 PMCID: PMC4269628 DOI: 10.1007/s40121-014-0040-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Indexed: 11/27/2022] Open
Abstract
Introduction The number of drug shortages in the United States has increased in recent years. While some literature exists on factors that contribute to antimicrobial shortages, the need remains to accurately gage the level of patient harm incurred as a result of realized antimicrobial shortages. Furthermore, current methods of reporting adverse drug events are known to under-report instances of patient harm. We sought to develop an ongoing and accurate method of reporting patient harm due to antimicrobial shortages, which was convenient, anonymous, and allowed clinicians to estimate the causality due to a shortage. Methods We distributed a public SurveyMonkey® (SurveyMonkey, Palo Alto, CA, USA) link to gather information regarding institution (for de-duplicating purposes), patient age, sex, antimicrobial product on shortage, type of infection requiring treatment or prophylaxis, adverse event, and patient outcome. Results To date complete data were reported on four patients being treated for infections that included Stenotrophomonas maltophilia bacteremia, Pneumocystis jirovecii pneumonia, neonatal sepsis of unknown etiology, and cytomegalovirus colitis. Antimicrobials that were unavailable to patients included sulfamethoxazole–trimethoprim, gentamicin, and foscarnet. Two adverse events (a delay in treatment and an inability to treat with other antimicrobials due to resistance) were attributed with probable causality due to a shortage, while the remaining adverse events (death and an inability to tolerate high oral doses) were attributed to have unlikely and possible causalities due to a shortage, respectively. Conclusion These methods encourage reports of antimicrobial shortage harms. Electronic supplementary material The online version of this article (doi:10.1007/s40121-014-0040-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Milena M McLaughlin
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Erik Skoglund
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Zachary Pentoney
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Marc H Scheetz
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA.
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA.
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Green RS, Gorman SK. Emergency department antimicrobial considerations in severe sepsis. Emerg Med Clin North Am 2014; 32:835-49. [PMID: 25441038 DOI: 10.1016/j.emc.2014.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Severe sepsis and septic shock are common problems in the emergency department patient population and require expert clinical skill by members of the emergency department team to maximize optimal patient outcomes. Although various guidelines have been developed for the management of these patients, issues around antimicrobial-related considerations in critically ill patients require further evidence-based attention. In this review article, important factors related to patient illness, microorganism, timing of antimicrobial administration, and source control are discussed.
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Affiliation(s)
- Robert S Green
- Division of Critical Care Medicine, Department of Anesthesia, Faculty of Medicine, Trauma Nova Scotia, Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada; Department of Emergency Medicine, Faculty of Medicine, Trauma Nova Scotia, Dalhousie University, Room 377 Bethune Building, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada.
| | - Sean K Gorman
- Clinical Quality & Research, Critical Care, Pharmacy Services, Interior Health Authority, Faculty of Pharmaceutical Sciences, The University of British Columbia, #200-1835 Gordon Drive, Kelowna, British Columbia V1Y3H5, Canada
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Fox ER, Sweet BV, Jensen V. Drug shortages: a complex health care crisis. Mayo Clin Proc 2014; 89:361-73. [PMID: 24582195 DOI: 10.1016/j.mayocp.2013.11.014] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 12/15/2022]
Abstract
National tracking of drug shortages began in 2001. However, a significant increase in the number of shortages began in late 2009, with numbers reaching what many have termed crisis level. The typical drug in short supply is a generic product administered by injection. Common classes of drugs affected by shortages include anesthesia medications, antibiotics, pain medications, nutrition and electrolyte products, and chemotherapy agents. The economic and clinical effects of drug shortages are significant. The financial effect of drug shortages is estimated to be hundreds of millions of dollars annually for health systems across the United States. Clinically, patients have been harmed by the lack of drugs or inferior alternatives, resulting in more than 15 documented deaths. Drug shortages occur for a variety of reasons. Generic injectable drugs are particularly susceptible to drug shortages because there are few manufacturers of these products and all manufacturers are running at full capacity. In addition, some manufacturers have had production problems, resulting in poor quality product. Although many suppliers are working to upgrade facilities and add additional manufacturing lines, these activities take time. A number of stakeholder organizations have been involved in meetings to further determine the causes and effects of drug shortages. A new law was enacted in July 2012 that granted the Food and Drug Administration additional tools to address the drug shortage crisis. The future of drug shortages is unknown, but there are hopeful indications that quality improvements and additional capacity may decrease the number of drug shortages in the years to come.
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Affiliation(s)
- Erin R Fox
- University of Utah Hospitals and Clinics, Salt Lake City.
| | | | - Valerie Jensen
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD
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McLaughlin M, Kotis D, Thomson K, Harrison M, Fennessy G, Postelnick M, Scheetz M. Empty shelves, full of frustration: consequences of drug shortages and the need for action. Hosp Pharm 2014; 48:617-8. [PMID: 24421528 DOI: 10.1310/hpj4808-617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Milena McLaughlin
- Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois; ; Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
| | - Despina Kotis
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
| | | | | | - Gary Fennessy
- Northwestern Memorial HealthCare, Chicago, Illinois. Corresponding author: Milena McLaughlin, PharmD, Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st Street, Downers Grove, IL 60515; phone: 630-515-6275; fax: 630-515-6958; e-mail:
| | - Michael Postelnick
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
| | - Marc Scheetz
- Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois; ; Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois
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Gundlapalli AV, Beekmann SE, Graham DR, Polgreen PM. Perspectives and concerns regarding antimicrobial agent shortages among infectious disease specialists. Diagn Microbiol Infect Dis 2013; 75:256-9. [PMID: 23305775 DOI: 10.1016/j.diagmicrobio.2012.11.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 11/06/2012] [Accepted: 11/16/2012] [Indexed: 10/27/2022]
Abstract
Antimicrobial shortages have made treating certain infections more difficult. A web-based survey asking about experience with antimicrobial drug shortages was distributed in 2011 to 1328 infectious diseases physician members of the Emerging Infectious Diseases Network of the Infectious Diseases Society of America. A majority (78%) of 627 respondents reported needing to modify antimicrobial choices because of drug shortages within the past 2 years. Antimicrobials most often reported as not available or available but in short supply were trimethoprim-sulfamethoxazole injection (by 65% of respondents), amikacin (by 58%), aztreonam (by 31%), and foscarnet (by 22%). Most respondents (55%) reporting a shortage indicated that the shortage adversely affected patient outcomes and that they were forced to use alternative and second line agents which were either less effective, more toxic, or more costly. Most (70%) indicated that they learned about the shortage from contact with the pharmacy after trying to prescribe a drug in short supply. More effective means of informing physicians about drug shortages is critical to lessen the impact on patient care.
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Affiliation(s)
- Adi V Gundlapalli
- University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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Griffith MM, Pentoney Z, Scheetz MH. Antimicrobial Drug Shortages: A Crisis Amidst the Epidemic and the Need for Antimicrobial Stewardship Efforts to Lessen the Effects. Pharmacotherapy 2012; 32:665-7. [DOI: 10.1002/j.1875-9114.2012.01158.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Zachary Pentoney
- College of Pharmacy, Midwestern University, Chicago; College of Pharmacy Downers Grove; Illinois
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