February News and Events

The nation is facing alarming shortages of a broad range of antimicrobial agents, according to a new report from the Infectious Diseases Society of America’s (IDSA) Emerging Infections Network (EIN). Nearly 90% of IDSA members who responded to the network’s survey say that, since September 1, 1999, they’ve experienced a shortage of at least one of these key drugs: meropenem, penicillin G, ticarcillin/clavulanate, cefazolin, and gentamicin. Additionally, 81% reported that inadequate supplies of these agents have caused them or their colleagues to change treatment regimens—a development that respondents said has affected about 10,000 of their patients nationwide. While it’s well known that supplies of penicillin G are critically low after its main U.S. manufacturer abruptly stopped making it in 1999, experts say that the reported shortage of other agents and its impact on patients was both unexpected and a cause for concern. “I’m surprised at how widespread the problem appears to be,’’ said IDSA President Catherine Wilfert, MD. “It’s not just a single drug, like penicillin G, which initially called attention to this issue. It’s a much broader and more serious problem than we thought.” “This is perhaps a wake-up call—that something (supplies of antimicrobials) that we’ve always taken for granted is in jeopardy,’’ said Larry Strausbaugh, MD, a Portland, OR–based infectious disease specialist who heads the EIN. “And this may only be the tip of the iceberg. We may only be seeing a fraction of [practitioners] having difficulties with supplies of these drugs.” Sixty-three percent of the 764 U.S. IDSA members surveyed returned their questionnaires, which were mailed in late November 1999. While shortages of penicillin G were reported by 76% of those responding, half of respondents also reported difficulties with supplies of gentamicin. Nearly 40% reported shortages of meropenem, and 24% said they had experienced shortages of ticarcillin/clavulanate. The questionnaire also asked infectious disease specialists to write in other drugs for which supplies have been inadequate. Drugs named included amoxicillin, ampicillin, bactrim, cefotetan, and nafcillin. Strausbaugh, Wilfert, and other experts called for more investigation into the causes of the shortages. In particular, Michael T. Osterholm, the chairman of IDSA’s emerging infections committee, urged further evaluation of the pharmaceutical industry’s “just-in-time’’ delivery system. Osterholm noted that concerns about this system and its possible effects on antimicrobial supplies had been raised at committee meetings in the fall of 1999. The documentation of shortages shortly after the industry’s move to the just-in-time inventory system strongly suggests a link, he said. “We have to look at all the factors that may be involved, but the shortages are a relatively new development, and so is the transition to this type of inventory system,”Osterholm said. Making the need for more evaluation particularly urgent are two concerns: antibiotic resistance that could occur from substituting broad-spectrum drugs for narrow-spectrum agents and the need to have adequate supplies in the event of a major outbreak or bioterrorism event. “The episodic nature of infectious disease is such that having a razor-thin inventory of antimicrobial agents will not suffice,’’ Osterholm said. Both Wilfert and Strausbaugh urged clinicians to take appropriate steps to ensure adequate supplies at their own facilities and to raise awareness of the problem both inside and outside the medical profession. “There’s a need for input from persons from the frontlines about the havoc that shortages can wreak,’’ Strausbaugh said.