Antibiotic Drug Shortages: Addressing a Common Problem

MAY 20, 2015
“Ask your doctor if [insert prescription drug name here] is right for you.”
 
If you watch TV at all, you hear that advice multiple times a day for any number of prescription drugs that treat everything from toenail fungus to chronic obstructive pulmonary disease. But, imagine if a doctor told you one of those drugs would be right for you if it weren’t for a shortage of it.
 
That’s not likely, since pharmaceutical companies spend 19 times more on marketing—with those commercials being no small part of the budget—than they do on research. Thus, they are unlikely to create demand for one of those drugs, only to have them unavailable when the would-be consumer comes calling.
 
However, that’s not true for all pharmaceuticals. Hospitals are routinely running short of critical antibiotics, often for months at a time, according to the findings of a study published last month in the Oxford Journal of Clinical Infectious Diseases.
 
A team of researchers looked at drug shortage data from the University of Utah Drug Information Service database, focusing specifically on shortages of antibiotics in the United States from 2001 to 2013.
 
They discovered 148 antibacterial drugs were in short supply at one time or another during that time period.

“The median number of new shortages per year was 10 [and] the median shortage duration was 188 days,” the study authors wrote. “Twenty-two percent of drugs experienced multiple shortage periods.”
 
Meropenem, which is used to treat bacterial meningitis among other things, was in short supply at 7 different times during the study period for a total of 1114 days. Doxycycline, an antibiotic used to treat Lyme disease, pneumonia, sinusitis and pelvic inflammatory disease, ran short 3 times for a total of 1515 days.
 
“Shortages of agents used to treat multidrug-resistant infections are of concern due to continued transmission and limited treatment options,” the authors concluded.

“These shortages often impact clinicians’ ability to treat infections,” they wrote, warning that a “high proportion of recent drug shortages involved broad-spectrum agents, injectable drugs, medications with no alternative sources, or those used on pathogens with limited alternative treatment options or in pediatric patients.”
 
What's even more problematic is that these are common antibiotics, not exotic drugs or even so-called “orphan” drugs, which are only rarely needed. They’re front-line drugs used every day—or at least when they’re available.

It’s worth also remembering that this study only looked at a single category of pharmaceuticals. If we extrapolate its findings to other drug categories, one must wonder what other pharmaceuticals experience problematic intermittent shortages.
 
To address shortages in the competitive sectors of the market, the FDA can usually help facilitate production of generic drugs—and many antibiotics have generic versions available. Compounding is another option for filling the gap in the commercial market.
 
However, these sporadic shortages are often attributable in part to merging drug companies, which results in the consolidation of their manufacturing facilities. That’s when the solutions get trickier, because manufacturers that legally obtain a market monopoly are free to raise their prices, and there’s little the FDA or any other agency can do about it.
 
One thing is certain, though: there will likely never be a shortage of efinaconazole (Jublia) to treat toenail fungus, especially now that flip flop season is upon us.

Darby Brown, RPh
Darby Brown, RPh
Darby Brown, RPh, is the founder and CEO of Brown's Compounding Center, a compounding pharmacy in Colorado. Connect with him on Twitter at @dbrownrph.
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