ARTICLE: Antimicrobial Access in the 21st Century: Delays and Critical Shortages

AUTHORS: Shmuel Shoham, Annukka Antar, Paul Auwaerter, Christine Durand, Mark Sulkowski and Deborah Cotton

JOURNAL: Ann Intern Med. 2016 Mar 22. doi: 10.7326/M15-3076. [Epub ahead of print]

A young woman with a bone marrow transplant and relapsed leukemia is placed on a regimen of the antibiotic imipenem–cilastatin due to a shortage of meropenem, the preferred drug. She has a seizure, a known complication that is more common with imipenem–cilastatin. An elderly kidney transplant recipient has an interruption in maintenance pyrimethamine therapy for central nervous system toxoplasmosis because of a substantial increase in the cost of the drug. Her encephalopathy recurs.

These cases point to failures in the antimicrobial supply chain. Transplant patients frequently develop infections and often require treatment with several anti-infectives. Such immunosuppressed patients are the sentinels of systemic problems that also put other, healthier patients at risk. Failure to avoid what should be preventable shortages is a failure on our part to meet the basic responsibility of modern medicine to keep patients free of harm.

When antimicrobial shortages are coupled with the dynamics of serious infections, the results can be catastrophic. As antimicrobial resistance has increased, so has demand for broad-spectrum drugs like meropenem, which was indicated for the young woman with leukemia. Because most of the anti-infective armamentarium is no longer under patent protection but is in generic form, these older drugs seem more prone to shortages than current brand-name drugs (1). Antimicrobials comprise about 16% of all critical drug shortages in the United States and most shortages in Europe (2). Current U.S. shortages include amikacin, ampicillin–sulbactam, cefazolin, cefotaxime, cefepime, ceftazidime, ceftriaxone, imipenem, meropenem, piperacillin–tazobactam, tigecycline, tobramycin, and vancomycin (3).

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