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Ideas and Opinions |5 July 2016

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

Shmuel Shoham, MD; Annukka A.R. Antar, MD, PhD; Paul G. Auwaerter, MD, MBA; Christine M. Durand, MD; Mark S. Sulkowski, MD; Deborah J. Cotton, MD, MPH

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at www.annals.org on 22 March 2016.
  • From Johns Hopkins University School of Medicine, Baltimore, Maryland, and Boston University School of Medicine, Boston, Massachusetts.

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-3076.

    Requests for Single Reprints: Shmuel Shoham, MD, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 447, Baltimore, MD 21205; e-mail, sshoham1@jhmi.edu.

    Current Author Addresses: Dr. Shoham: Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 447, Baltimore, MD 21205.

    Dr. Antar: Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 450-B, Baltimore, MD 21205.

    Dr. Auwaerter: The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins Medicine, 725 North Wolfe Street, PTCB - Room 231, Baltimore, MD 21287.

    Dr. Durand: Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 450-D, Baltimore, MD 21205.

    Dr. Sulkowski: Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 445, Baltimore, MD 21205.

    Dr. Cotton: Boston University School of Medicine, One Boston Medical Center Place, Dowling 3 North, 3118, Boston, MA 02118.

    Author Contributions: Conception and design: S. Shoham, A.A.R. Antar.

    Analysis and interpretation of the data: S. Shoham.

    Drafting of the article: S. Shoham, A.A.R. Antar, P.G. Auwaerter, C.M. Durand, M.S. Sulkowski.

    Critical revision of the article for important intellectual content: S. Shoham, A.A.R. Antar, P.G. Auwaerter, M.S. Sulkowski, D.J. Cotton.

    Final approval of the article: S. Shoham, A.A.R. Antar, P.G. Auwaerter, C.M. Durand, M.S. Sulkowski, D.J. Cotton.

    Administrative, technical, or logistic support: S. Shoham.

    Collection and assembly of data: A.A.R. Antar.

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FULL TEXT
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 (...
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Shoham S, Antar AA, Auwaerter PG, Durand CM, Sulkowski MS, Cotton DJ. Antimicrobial Access in the 21st Century: Delays and Critical Shortages. Ann Intern Med. [Epub ahead of print 22 March 2016]165:53–54. doi: 10.7326/M15-3076

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Published: Ann Intern Med. 2016;165(1):53-54.

DOI: 10.7326/M15-3076

Published at www.annals.org on 22 March 2016

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2016 American College of Physicians
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