Decreasing availability of drugs linked to adverse patient outcomes

BOSTON — Results of a 2011 survey of infectious disease physicians indicate that more than three-quarters of respondents were forced to modify antimicrobial choices due to drug shortages within the past 2 years. In addition, the majority of respondents who had experienced shortages reported subsequent adverse patient outcomes, according to data presented here.

Between May and June 2011, Susan E. Beekmann, RN, MPH, of the University of Iowa Carver College of Medicine, and colleagues administered a web-based survey among infectious disease physicians to assess experiences with antimicrobial drug shortages.

Of 503 responses, 78% reported a need to modify their antimicrobial choice for treating an infectious disease because of a drug shortage within the past 2 years. Antimicrobials identified as being in shortage included trimethoprim-sulfamethoxazole (65%), amikacin (58%), aztreonam (31%) and foscarnet (22%).

Fifty-five percent of respondents who experienced drug shortages also indicated an adverse affect on patient outcomes, mostly due to shortages of trimethoprim-sulfamethoxazole (64%) and amikacin (56%), both used to treat gram-negative rod infections.

Commonly reported adverse events included use of more toxic antimicrobials (64%), use of more costly agents (43%), use of broader-spectrum antimicrobials than required by antimicrobial susceptibilities (40%), longer hospitalizations (30%) and long-term morbidity from inadequate treatment of infection (30%). Five respondents reported that the shortage was associated with patient death, according to the study.

Further, 70% of respondents learned about the shortage from contact with a pharmacy, and only 26% of members learned about shortages from official sources.

"The GAO is now conducting a study to better understand drug shortages and to identify the steps that the FDA could take to better identify and resolve drug shortages," Beekmann told Infectious Disease News. "IDSA is aware of this issue and has been taking action to promote legislative activity."

"This is a problem at the local level, at the national level and at the global level," Infectious Disease News Editorial Board member, and president of IDSA, James M. Hughes, MD, said during a press conference. "It's a problem for patients, for clinicians that are doctors, and for public health officials. We're in an era of increasing drug resistance of bacterial infections, and we're also in an era of decreasing drug development and decreasing drug availability."

"In 2010, [IDSA] launched the 10 x '20 initiative calling for the development of ten new systemic antimicrobial agents by 2020," Hughes said. "There's a need not only for development of drugs, but also for development of rapid point of care diagnostics in order to facilitate physicians' decisions about selection of appropriate antibiotics to treat patients." - by Ashley DeNyse

For more information:

• Beekman SE. #161.Presented at: The IDSA 49th Annual Meeting; Oct. 20-23, 2011; Boston.

Disclosure: The researchers report no relevant financial disclosures.

Although anecdotal survey data can be questioned, the large number of respondents reporting antimicrobial shortage that caused changes in planned therapy was impressive. 'Bad bugs: No drugs' takes on an additional meaning when 224 IDSA care givers say a drug shortage resulted in an adverse outcome, including death. Beekmann and colleagues point out the need to assure resources to maintain availability of agents such as TMP/SMX IV, which remains a primary treatment for many life-threatening infections. In our electronic age, the lack of communication of drug shortages to treating physicians is unconscionable.

– George A. Pankey, MD

Infectious Disease News Editorial Board member

Disclosure: Dr. Pankey reports no relevant financial disclosures.

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