Patients in the United States expect that hospitals will be able to treat their infections, but a growing number of drug shortages challenges that assumption. From 2001-2013, U.S. hospitals experienced 148 antibacterial drug shortages. These are seldom fleeting events—the mean shortage lasted nine months during this period and nearly a quarter of antibacterial drugs had multiple periods of unavailability or limited availability, according to a recent study published in Clinical Infectious Diseases.1
The trend shows more shortages in the future. The number of shortages rose sharply in 2007, from an average of 10 drugs per month to an average of 18 drugs per month. At the end of the study period, 26 drugs had unresolved shortages.
These shortages directly impact care and increase risk in the hospital setting. About half of the antibacterials affected by shortages involved drugs used in treatment of high-risk, multidrug resistant pathogens such as Clostridium difficile, carbapenem-resistant.
Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus, extended-spectrum beta-lactamase-producing organisms and Pseudomonas aeruginosa. The researchers noted that many of the recent drug shortages involved broad-spectrum agents as well as injectable drugs and medications with no alternative sources.
For patients and providers, these shortages cause great concern as the shortages frequently affect therapies with no effective substitutes or for which the options available pose higher risks and have lower efficacy rates. A survey of more than 600 infectious disease physicians reported that 78% had modified their antibacterial choices due to shortages and the majority felt that shortages negatively affected patient outcomes. Another survey reported that shortages resulted in adverse outcomes 20% of the time and consumed significant clinical resources to develop an action plan in the absence of suitable alternatives.
The combination of antibacterial drug shortages and a dearth of new agents in development makes effective antimicrobial stewardship practices more imperative than ever. Antimicrobial stewardship programs help hospitals conserve broad-spectrum drugs by providing guidelines for their use, including appropriate indication, dosage and duration.
The researchers suggest that antimicrobial stewardship teams led by a pharmacist should closely track and communicate inventory levels for critical antibacterials and develop contingency plans for shortages. In addition, the team should develop guidelines to ensure the use of the narrowest appropriate agent based on lab results, promote prompt IV-to-oral conversion to conserve drugs that frequently experience shortages, safeguard access to key drugs for patients with the most need, and educate clinicians on the appropriate protocols for alternative therapies.
How has your hospital dealt with antibacterial drug shortages?
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. Clinical Infectious Diseases. April 22, 2015.