Methods: In early 2016, the EIN distributed a web-based survey to ID physician members asking about antimicrobial drug shortages. The agents in short supply, concern for adverse outcomes, and communication about shortages were the themes of the survey.
Results: 44% (701/1597) of members responded. 491 (70%) of respondents reported the need to modify their antimicrobial choice because of a shortage in the past 2 years. A majority (73%) reported the shortages affected patient care or outcomes; the use of broader-spectrum (75%), more costly (58%), less effective second-line (45%), or more toxic agents (37%) were of most concern. The top 10 antimicrobials in short supply were piperacillin-tazobactam, ampicillin-sulbactam, meropenem, cefotaxime, cefepime, trimethoprim-sulfamethoxazole (TMP-SMX), doxycycline, imipenem, acyclovir, and amikacin. Cost was a factor in prescribing pyrimethamine and doxycycline. Respondents learned of shortages from hospital notification (76%), from a colleague (56%), contact from pharmacy after ordering the agent in short supply (53%), or FDA/other website on shortages (23%). The antimicrobial stewardship programs of a majority (83%) of respondents’ institutions had developed guidelines to deal with shortages.
From 2011 to 2016, more respondents noted adverse patient outcomes relating to shortages; 253 (51%) to 358 (73%), p<.0001. Trimethoprim-sulfamethoxazole and acyclovir were in short supply at both time points. The most common ways of learning about a shortage changed from notification after trying to prescribe a drug in short supply in 2011 to proactive hospital/system (local) notification in 2016. 71% indicated that communications in 2016 were sufficient.
Conclusion: The persistence of antibiotic shortages reported 5 years after the last survey is disturbing, as is the continued need to use broader-spectrum or more toxic agents. Although ID physicians are learning about shortages sooner, more local system resources are now needed both for communications and antimicrobial stewardship programs in order to respond to persistent, recurrent, and rotating antimicrobial shortages.
D. Graham, Theravance Biopharma US Inc.: Investigator and Speaker's Bureau , Research grant and Speaker honorarium
P. M. Polgreen, None