Hospitals facing antibiotics shortage

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Quote at end of story:

"It is shocking to us the rate we are experiencing drug shortages, and not just with antibiotics," Como said. "The crisis will come if there is ever a shortage of the alternatives."

Hospitals facing antibiotics shortage

02/03/2000

JOHN GEROME

News staff writer

Some Birmingham hospitals are experiencing a shortage of penicillin G and other antibiotics, forcing doctors to find substitute drugs to treat serious infections.

Hospital officials said Wednesday that the shortage poses no threat to patients because the alternative medications work just as well and are plentiful.

"In the vast majority of cases you can find an alternative," said Jackson Como, director of drug information for UAB Hospital. "In fact, there are probably only a handful of situations where one of these agents would be uniquely indicated," and there is a large enough emergency supply to handle those occasions.

The antibiotics in question are penicillin G, gentamicin, meropenem and ticarcillin/ clavulanate. Doctors use them to treat several infections including pneumonia, meningitis, strep throat, gonorrhea and syphilis.

A recent survey by the Infectious Diseases Society of America found that many of its members had experienced a shortage of at least one of the drugs, according to a report in The Wall Street Journal. The group represents infectious disease physicians based in hospitals around the country.

Officials at UAB and Children's Hospital said Wednesday that they anticipated the shortage and were able to stock up in advance.

Arthur Mueller, director of pharmacy services at Baptist Medical Center Montclair, said he has had a hard time getting penicillin G for at least six months. Gentamicin also was a problem several months ago, he said, but is now available.

"There is one pharmaceutical company that can get us a supply of penicillin G on an emergency basis, so we can get it when we need it," Mueller said.

Cullen Clark, marketing coordinator of Carraway Methodist Medical Center, said that in many cases, doctors prefer using the alternatives to penicillin G, one of the older antibiotics. The alternatives are newer, he said, and treat a broader range of infections.

Reasons for the shortage are mixed. Some blame manufacturing shutdowns and strict federal regulations. Others point to the pharmaceutical industry's trend toward keeping leaner inventories to save money. Still others suspect drug hoarding by hospital pharmacies in anticipation of Y2K.

"It is shocking to us the rate we are experiencing drug shortages, and not just with antibiotics," Como said. "The crisis will come if there is ever a shortage of the alternatives."

) 2000 The Birmingham News. Used with permission.

http://www.al.com/news/birmingham/Feb2000/3-e372685b.html

-- Carl Jenkins (Somewherepress@aol.com), February 03, 2000

Answers

Interesting, thanks Carl!
Y2K Hoarding Blame -- thought everything was too peachy for that to ever come up! ;^)

-- Ashton & Leska in Cascadia (allaha@earthlink.net), February 03, 2000.

Only an alarmist would have expected shortages of lifesaving drugs.

Honestly people, is it me or have things gone from bad to worse?

There have been hundreds of reports of little wacky problems.

While I don't think the airline crashes are Y2K, it's strange that, on average there are one or two major crashes per year but this year, we've had two already and seen several other incidents. It's almost as if maintenance isn't happening on schedule or something else vague is going wrong.

-- cory (kiyoinc@ibm.XOUT.net), February 03, 2000.


Cory,

Accidents happen all the time......

'puters don't really run anything important.....

All problems can be FOF'ed....

There was no need to spend Billions on Y2k fixes...

If you Prepared, you are an Idiot..

Y2k passed without a whimper.

Airplanes won't fall from the skys :-(

-- Casper (c@no.yr), February 03, 2000.


Then there is AWL....... :-)

-- Casper (c@no.yr), February 04, 2000.

I seem to remember something about pharmaceutical supplies being 80% from abroad and the "abroad" not being quite up to par: (compliant?) Of course NOT Y2K.....but "otherwise"?....

I wonder if this might have anything to do with shortages? Just a query...not a statement.

-- Bird (Birdlady@nest.home), February 04, 2000.



<<< The antibiotics in question are penicillin G, gentamicin, meropenem and ticarcillin/clavulanate...a recent survey by the Infectious Diseases Society of America found that many of its members had experienced a shortage of at least one of the drugs... >>>

This is interesting, as I had not heard about any recent shortages of gentamicin (an old workhorse, one of the aminoglycoside class of antibiotics), meropenem (a more modern antibiotic) and Timentin (the trade name for ticar/clav, a not-so-new but very useful antibiotic combination of ticarcillin, related to penicillin, with a non- antibiotic drug, clavulanate, to increase the effectiveness of the ticarcillin).

As far as the penicillin G shortage, this is old news. I quote from the Centers for Disease Control and Prevention in their MMWR publication, October 29, 1999; the shortage was also announced earlier in many places (check out www.cdc.gov, and I'm sure there are other references at the FDA website www.fda.gov):

"In June 1999, Schein Pharmaceuticals, Inc announced that its subsidiary Marsam Pharmaceuticals was voluntarily recalling all of its penicillin products to address FDA's regulatory concerns at Schein Pharmaceutical's manufacturing site. Marsam Pharmaceuticals is a major manufacturer of finished product vials of penicillin G (potassium and sodium) in the U.S. It is unknown when this facility will resume distribution of these products. This situation has caused a shortage of these types of penicillin in many parts of the country."

The October MMWR news brief goes on to give information on alternatives. Fortunately there are many options. Technical assistance can be sought at the CDC website or at 888-232-3299 via a FAXBACK service.

I have not heard that the manufacture of pen G has resumed since that October update.

As far as the other abx shortages, I hadn't heard about them. These things do happen from time to time, although it seems a little unusual to me to have so many at the same time. Often the problem is a demand by FDA for changes in the factory, leading to a temporary shutdown until the regulators are happy. Safety comes first!

The fundamental problem is the "thinness" of the pharmaceutical industry, IMHO. There may be only a few or even only one company making a particular product, and if ANYTHING happens to the company or to its manufacturing facility, there will soon be a shortage. The same is true for other products; historically in the U.S. there has been only one maker for some of the childhood vaccines, for example. This lack of multiple sources is more likely with "older" products whose patent has run out, products with less profitability (which is often the same thing), and/or products with high legal liability concerns (many vaccines, for example). And in the run-up to the Rollover there was lots of discussion on the limited sources worldwide for insulin and some other crucial drugs.

No hint of Y2K issues with these antibiotics, but I'll see what I can find out.

On a basic level I think the shortages remind us of the razor's edge that modern society as a whole walks on all the time. A parallel might be the single manufacturing facility in Asia (was it Japan or Taiwan?) for the worldwide supply of computer DRAMs, that was offline after a fire and caused downstream delays...this was two or four years ago, no?

On the other hand, for the antibiotics, there ARE alternatives almost all the time. This may not always be true, for example with some of the newer antibiotic classes against certain drug-resistant bacteria, but that shouldn't be the case with the four antibiotics listed above.

--Andre in southcentral Pennsylvania public health physician

written 35 January 2000

-- Andre Weltman (aweltman@health.state.pa.us), February 04, 2000.


Oops, forgot to add this comment: regarding "Y2K hoarding," I am not aware (but not necessarily in a good position to know) that such hoarding even took place. Weren't we assured in various happy-faced press releases last month that NO drug "hoarding" had occurred?

I do know of a few Get-It physicians, including myself, who did stockpile relatively small amounts of antibiotics such as doxycycline and ciprofloxacin as part of personal preps; I can assure you that the amounts and specific types of antibiotics would not be causing the problems indicated in the news article above. Also, the personal stockpiles I know of were made far in advance of the Rollover--this is not the sort of thing one rushes out to the grocery store to buy as the first snowflakes begin to fall! (If you are wondering, my abx stash resides happily in a refrigerator where it will last a good number of years.)

Whatever is going on, I rather doubt it can be blamed on "hoarding."

--Andre in southcentral Pennsylvania

public health physician

Note my email address: I am speaking for myself, not my employer, etc etc etc.

-- Andre Weltman (aweltman@health.state.pa.us), February 04, 2000.


Andre Weltman, thank you for another excellent post.

Totally refreshing to see an issue addressed calmly and intelligently with facts. Made our day!

-- Ashton & Leska in Cascadia (allaha@earthlink.net), February 04, 2000.


You're welcome. --Andre

-- Andre Weltman (aweltman@health.state.pa.us), February 04, 2000.

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