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Davido B, Michelon H, Mamona C, de Truchis P, Jaffal K, Saleh-Mghir A. Efficacy of Expired Antibiotics: A Real Debate in the Context of Repeated Drug Shortages. Antibiotics (Basel) 2024; 13:466. [PMID: 38786194 PMCID: PMC11117793 DOI: 10.3390/antibiotics13050466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
This narrative review aims to discuss the main interest in and cautions associated with the use of expired antibiotics in the context of repeated shortages, notably in Europe. Articles concerning the topic of expiry dates related to antibiotic use were reviewed using keywords in the PubMed®/MEDLINE and Google Scholar databases to identify the most extensive evidence-based documentation. The present review evaluates the potential interest and efficacy of using expired drugs and their possible related adverse events. Overall, in the context of drug shortages, expiry dates could be safely extended for at least one year for most solid antibiotics (tablets or powder) used in daily clinical practice, as long as they are stored under the right conditions, in accordance with the summary of product characteristics.
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Affiliation(s)
- Benjamin Davido
- Hôpital Raymond Poincaré, Université Paris-Saclay, 92380 Garches, France; (H.M.); (C.M.); (P.d.T.)
- UMR 1173, Infection et Inflammation, Université Versailles-St-Quentin, 78000 Versailles, France;
| | - Hugues Michelon
- Hôpital Raymond Poincaré, Université Paris-Saclay, 92380 Garches, France; (H.M.); (C.M.); (P.d.T.)
| | - Christel Mamona
- Hôpital Raymond Poincaré, Université Paris-Saclay, 92380 Garches, France; (H.M.); (C.M.); (P.d.T.)
| | - Pierre de Truchis
- Hôpital Raymond Poincaré, Université Paris-Saclay, 92380 Garches, France; (H.M.); (C.M.); (P.d.T.)
| | - Karim Jaffal
- Hôpital Ambroise Paré, Université Paris-Saclay, 92100 Boulogne-Billancourt, France;
| | - Azzam Saleh-Mghir
- UMR 1173, Infection et Inflammation, Université Versailles-St-Quentin, 78000 Versailles, France;
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Murakami S, Akazawa M, Honda H. Difference between days of therapy and days of antibiotic spectrum coverage in an inpatient antimicrobial stewardship program: Vector autoregressive models for time-series analysis. Infect Control Hosp Epidemiol 2024; 45:459-466. [PMID: 37937440 DOI: 10.1017/ice.2023.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
OBJECTIVE The days of therapy (DOT) metric, used to estimate antimicrobial consumption, has some limitations. Days of antibiotic spectrum coverage (DASC), a novel metric, overcomes these limitations. We examined the difference between these 2 metrics of inpatient intravenous antimicrobial consumption in assessing antimicrobial stewardship efficacy and antimicrobial resistance using vector autoregressive (VAR) models with time-series analysis. METHODS Differences between DOT and DASC were investigated at a tertiary-care center over 8 years using VAR models with 3 variables in the following order: (1) the monthly proportion of prospective audit and feedback (PAF) acceptance as an index of antimicrobial stewardship efficacy; (2) monthly DOT and DASC adjusted by 1,000 days present as indices of antimicrobial consumption; and (3) the monthly incidence of 5 organisms as an index of antimicrobial resistance. RESULTS The Granger causality test, which evaluates whether incorporating lagged variables can help predict other variables, showed that PAF activity contributed to DOT and DASC, which, in turn, contributed to the incidence of drug-resistant P. aeruginosa. Notably, only DASC helped predict the incidence of drug-resistant Enterobacterales. Another VAR analysis demonstrated that a high proportion of PAF acceptance was accompanied by decreased DASC in a given month, whereas increased DASC was accompanied by an increased incidence of drug-resistant Enterobacterales, unlike with DOT. CONCLUSIONS The VAR models of PAF activity, antimicrobial consumption, and antimicrobial resistance suggested that DASC may more accurately reflect the impact of PAF on antimicrobial consumption and be superior to DOT for predicting the incidence of drug-resistant Enterobacterales.
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Affiliation(s)
- Shutaro Murakami
- Department of Pharmacy, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Hitoshi Honda
- Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
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3
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Mittal N, Mittal R, Singh S, Godara S. The Availability of Essential Antimicrobials in Public and Private Sector Facilities: A Cross-Sectional Survey in a District of North India. Antibiotics (Basel) 2024; 13:131. [PMID: 38391517 PMCID: PMC10886159 DOI: 10.3390/antibiotics13020131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024] Open
Abstract
(1) Background: There is a need to assess the availability of essential antimicrobials, as the availability of an antimicrobial is a critical element of its rational use. We aimed to assess the availability of antimicrobials listed in the National List of Essential Medicines 2015, India (primary list), and a selected (secondary) list comprised of agents indicated for commonly encountered infectious illnesses in various healthcare settings and to identify the reasons for their non-availability. (2) Methods: A cross-sectional survey of 25 public, private, and other sector pharmacies was carried out in Rohtak, a district of the North Indian state of Haryana, from April to June 2022. (3) Results: Most of the antimicrobials surveyed were optimally available in various sector pharmacies with the exception of benzathine benzylpenicillin, benzylpenicillin, cloxacillin, cefazolin, cefuroxime, cefadroxil, amphotericin B, and antimalarials. The most frequent reasons for limited availability were low demand, no prescriptions, and the non-listing of drugs in the state's essential medicine list. (4) Conclusions: Enough evidence needs to be generated with respect to the status of availability of essential antimicrobials from different regions of India as well as other lower-middle-income countries to devise measures for ascertaining better availability of these agents, especially antibiotics at regional, national, and global scales.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Rakesh Mittal
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Sukhbir Singh
- Department of Hospital Administration, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Sushila Godara
- Health Department, Government of Haryana, Panchkula 134109, Haryana, India
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Lőrinczy L, Turbucz B, Hankó B, Zelkó R. Managing Antibiotic Shortages in Inpatient Care-A Review of Recent Years in Comparison with the Hungarian Status. Antibiotics (Basel) 2023; 12:1704. [PMID: 38136738 PMCID: PMC10740991 DOI: 10.3390/antibiotics12121704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/26/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
This study aimed to summarize the screened articles on antibiotic shortages, compare them with the Hungarian Health Authority database, and identify the overlapping substances in shortages and handling practices. A systematic analysis was conducted using the provided keywords to filter out appropriate studies and incorporate them into this review. The studies were searched in the following databases: Reaxys, PubMed, Ovid, ScienceDirect, and Embase. The search time interval was 2000-2023, with the following keywords used: "antibiotic", "shortage", and "in clinic". The shortage data for Hungary were collected and integrated within the specified timeframe. This was achieved through a comprehensive screening method to ensure comparability between the data from the literature review and the database. Based on the comparison, we have identified two groups of ingredients, the overlapping and not-overlapping ingredients. The mitigation practices were also categorized and evaluated to recommend good shortage management practices for Hungarian decision-makers and healthcare professionals. Our key conclusion was to enhance a shortage risk-based approach, including the legislative, health authority, and healthcare professionals responsible for therapeutic protocol and procuring or producing the necessary product. A widely approved shortage risk-based framework should be created to mitigate the impacts, including communication protocols, individual therapy planning, compounding of magistral products, and antimicrobial stewardship programs. The most common mitigation strategy is the substitution with available alternatives, but besides, a good understanding and implementation of antimicrobial stewardship programs is also crucial.
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Affiliation(s)
| | - Béla Turbucz
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, 1085 Budapest, Hungary; (L.L.); (B.H.)
| | | | - Romána Zelkó
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, 1085 Budapest, Hungary; (L.L.); (B.H.)
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Sugiura S, Shimura H, Fujita K, Ogawa T, Nimura A. Comparison of ceftriaxone and cefazolin as prophylactic antibiotics for surgical site infection in orthopedic upper extremity surgery: The nationwide shortage of cefazolin in March 2019. J Orthop Sci 2023; 28:1018-1022. [PMID: 36089431 DOI: 10.1016/j.jos.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/22/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Due to the nationwide supply shortage of cefazolin in March 2019 in Japan, ceftriaxone was used as an alternative prophylaxis antibiotic agent. This retrospective study was designed to investigate the impact of cefazolin and ceftriaxone as a prophylactic antibiotic agent for surgical site infection (SSI) in orthopedic upper extremity surgery. METHODS We used cefazolin for antibiotic prophylaxis to prevent SSI before March 2019. Because of cefazolin shortage, ceftriaxone was used as an alternative agent in our hospital. From April 2014 to May 2021, 2493 upper extremity surgeries were reviewed. The exclusion criteria in this study were as follows: patients aged under 16 years, those with an open wound, those with infectious diseases, those who underwent trigger finger surgery, and those who underwent percutaneous pinning surgery. The incidence of deep SSI was evaluated according to the Centers for Disease Control and Prevention guidelines. RESULTS Among the 2493 eligible cases, 1674 were included in this study. In the cefazolin group, 1140 cases were included, whereas, in the ceftriaxone group, 534 cases were included. No significant differences in the demographic data of the patients were observed between the two groups. The incidence of deep SSI was 0.08% (1/1140 cases) in the cefazolin group and 1.1% (6/534 cases) in the ceftriaxone group, with a significant difference between the two groups (odds ratio, 12.9; p = 0.005). CONCLUSIONS This study indicated that the use of ceftriaxone instead of cefazolin after upper extremity surgery increases the risk of deep SSI.
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Affiliation(s)
- Sara Sugiura
- Department of Orthopedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Haruhiko Shimura
- Department of Orthopedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahisa Ogawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Izutsu KI, Ando D, Morita T, Abe Y, Yoshida H. Generic Drug Shortage in Japan: GMP Noncompliance and Associated Quality Issues. J Pharm Sci 2023; 112:1763-1771. [PMID: 36965844 DOI: 10.1016/j.xphs.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/27/2023]
Abstract
Government campaigns to replace off-patent brand pharmaceuticals with low cost generic products in national health insurance systems have apparently increased their production in the last two decades in Japan. The contamination of a batch of generic itraconazole tablets with the sleep inducer rilmazafone caused significant adverse events and related accidents in 2020, amidst increasing use of the generic products in healthcare. Investigations revealed many Good Manufacturing Practice (GMP) violations and other evidence of poor quality management in the manufacturing/marketing authorization holder (MAH). Urgent inspection of other MAHs found multiple cases of GMP noncompliance that resulted in temporary administrative suspension. Various quality issues, including nonconformity in stability monitoring, in these generic MAHs resulted in prolonged suspension of product shipments and shortages in medical institutions. These problems highlighted long-standing issues in quality management by MAHs and inspections by authorities, which had been neglected during rapid production expansion. This review introduces these manufacturing control and management problems and their countermeasures, and discusses the impact of habitual inadequate development processes that disregard the quality-by-design (QbD) perspective as the root cause of the issues.
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Affiliation(s)
- Ken-Ichi Izutsu
- Division of Drugs, National Institute of Health Sciences, Tonomachi 3-25-26, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-9501, Japan.
| | - Daisuke Ando
- Division of Drugs, National Institute of Health Sciences, Tonomachi 3-25-26, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-9501, Japan
| | - Tokio Morita
- Division of Drugs, National Institute of Health Sciences, Tonomachi 3-25-26, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-9501, Japan
| | - Yasuhiro Abe
- Division of Drugs, National Institute of Health Sciences, Tonomachi 3-25-26, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-9501, Japan
| | - Hiroyuki Yoshida
- Division of Drugs, National Institute of Health Sciences, Tonomachi 3-25-26, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-9501, Japan
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Nagano H, Shin JH, Kunisawa S, Fushimi K, Nagao M, Imanaka Y. Impact of the cefazolin shortage on the selection and cost of parenteral antibiotics during the supply disruption period in Japan: A controlled interrupted time series analysis. J Infect Public Health 2023; 16:467-473. [PMID: 36738690 DOI: 10.1016/j.jiph.2023.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A serious shortage of cefazolin (CEZ) occurred in Japan in 2019. We compared the impact of the CEZ shortage on the selection of parenteral antibiotics at affected and non-affected hospitals. METHODS The data were extracted from a nationwide Japanese administrative database and included all hospitalized cases between April 2016 and December 2020. We defined 'hospitals with shortage' as those hospitals with a statistically significant decrease in the use of CEZ during the supply disruption period compared to the same months of the previous year; other hospitals as 'hospitals without shortage'. We determined the proportion of each selected parenteral antibiotic use to the sum of all selected antibiotic use in the two groups of hospitals during the supply disruption period and during the same months of the previous year. A controlled interrupted time series (CITS) analysis was conducted to estimate the impact of the CEZ shortage on each antibiotic use and the cost of all parenteral antibiotics per patient day in hospitals with shortage as compared to those without shortage. RESULTS In the hospitals with shortage, the proportion of CEZ use to the sum of all selected antibiotics decreased (23.5-11.1%). The decrease in CEZ use was mainly offset by the use of ceftriaxone, ceftriaxone, and ampicillin/sulbactam. The CITS analysis showed a statistically significant increase in the use of broader-spectrum beta-lactams and clindamycin during the supply disruption period (flomoxef up 58.1%, cefotiam up 63.1%, cefmetazole up 14.5%, ceftriaxone up 13.9%, and clindamycin up 20.1%). The analysis showed no statistically significant change in the cost of all parenteral antibiotics per patient day. CONCLUSIONS During the CEZ supply disruption, there was a statistically significant increase in the use of broader-spectrum beta-lactams and clindamycin in hospitals with shortage compared with those without shortage.
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Affiliation(s)
- Hiroyuki Nagano
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Sharaf YA, Ibrahim AE, El Deeb S, Sayed RA. Green Chemometric Determination of Cefotaxime Sodium in the Presence of Its Degradation Impurities Using Different Multivariate Data Processing Tools; GAPI and AGREE Greenness Evaluation. Molecules 2023; 28:molecules28052187. [PMID: 36903432 PMCID: PMC10005094 DOI: 10.3390/molecules28052187] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
Four eco-friendly, cost-effective, and fast stability-indicating UV-VIS spectrophotometric methods were validated for cefotaxime sodium (CFX) determination either in the presence of its acidic or alkaline degradation products. The applied methods used multivariate chemometry, namely, classical least square (CLS), principal component regression (PCR), partial least square (PLS), and genetic algorithm-partial least square (GA-PLS), to resolve the analytes' spectral overlap. The spectral zone for the studied mixtures was within the range from 220 to 320 nm at a 1 nm interval. The selected region showed severe overlap in the UV spectra of cefotaxime sodium and its acidic or alkaline degradation products. Seventeen mixtures were used for the models' construction, and eight were used as an external validation set. For the PLS and GA-PLS models, a number of latent factors were determined as a pre-step before the models' construction and found to be three for the (CFX/acidic degradants) mixture and two for the (CFX/alkaline degradants) mixture. For GA-PLS, spectral points were minimized to around 45% of the PLS models. The root mean square errors of prediction were found to be (0.19, 0.29, 0.47, and 0.20) for the (CFX/acidic degradants) mixture and (0.21, 0.21, 0.21, and 0.22) for the (CFX/alkaline degradants) mixture for CLS, PCR, PLS, and GA-PLS, respectively, indicating the excellent accuracy and precision of the developed models. The linear concentration range was studied within 12-20 μg mL-1 for CFX in both mixtures. The validity of the developed models was also judged using other different calculated tools such as root mean square error of cross validation, percentage recoveries, standard deviations, and correlation coefficients, which indicated excellent results. The developed methods were also applied to the determination of cefotaxime sodium in marketed vials, with satisfactory results. The results were statistically compared to the reported method, revealing no significant differences. Furthermore, the greenness profiles of the proposed methods were assessed using the GAPI and AGREE metrics.
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Affiliation(s)
- Yasmine Ahmed Sharaf
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44511, Egypt
| | - Adel Ehab Ibrahim
- Natural and Medical Sciences Research Center, University of Nizwa, P.O. Box 33, Birkat Al Mauz, Nizwa 616, Oman
- Pharmaceutical analytical chemistry Department, Faculty of Pharmacy, Port-Said University, Port-Said 42526, Egypt
| | - Sami El Deeb
- Natural and Medical Sciences Research Center, University of Nizwa, P.O. Box 33, Birkat Al Mauz, Nizwa 616, Oman
- Institute of Medicinal and Pharmaceutical Chemistry, Technische Universitaet Braunschweig, 38106 Braunschweig, Germany
- Correspondence: ; Tel.: +49-531-391-7301
| | - Rania Adel Sayed
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44511, Egypt
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Izutsu KI, Abe Y, Kurita M, Yoshida H. [Shortages of Prescription Drugs Due to Compliance and Quality Issues in Japan]. YAKUGAKU ZASSHI 2023; 143:139-152. [PMID: 36418079 DOI: 10.1248/yakushi.22-00185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Several good manufacturing practice (GMP) compliance issues and their associated quality problems that have been revealed since 2020 have led to large-scale recalls and supply suspensions of drug products in Japan. This paper provides an overview of the causes and countermeasures for supply disruptions of low-molecular-weight chemical pharmaceutical agents, focusing on quality-related issues. A recent increase in the use of generic drugs emphasized the importance of strengthening active pharmaceutical ingredient (API) supply chains and ensuring GMP compliance among drug manufacturers. In addition, increasing recalls in the drug products of certain marketing authorization holders due to storage stability problems strongly suggests the need to improve their development process considerably. Other measures to stabilize the supply of pharmaceuticals, including increasing stockpiles of APIs, were also discussed.
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Affiliation(s)
| | - Yasuhiro Abe
- Division of Drugs, National Institute of Health Sciences
| | - Mari Kurita
- Division of Drugs, National Institute of Health Sciences
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Alemkere G, Teshome A, Temesgen G, Abebe G, Degefaw Y, Tilahun H, Getahun W, Girma E, Amogne W. Cefazolin access and use in Ethiopia: A policy implication. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001421. [PMID: 36962932 PMCID: PMC10021613 DOI: 10.1371/journal.pgph.0001421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/17/2022] [Indexed: 01/19/2023]
Abstract
Healthcare systems in resource-limited nations have been challenged by the shortage of essential medicines. This study explores cefazolin access and uses history in the Ethiopian healthcare delivery system, for possible policy implications. An exploratory qualitative study was conducted from July to August 2021. Semi-structured questions and observation guides were used to extract necessary data from people, documents, and field visits to hospitals, government supply agencies, and pharmaceutical business firms. The data were transcribed, coded, organized into themes, and presented. Cefazoline is the recommended first-line surgical antibiotic prophylaxis (SAP) in the Ethiopian Standard Treatment Guideline (STG) and is included in the national Essential Medicine List (EML). However, it was not available for use in the Ethiopian pharmaceutical markets for years. While the shortage might stem from supply-demand mismatches, multiple unknown issues exist in the background of the shortage. This is evidenced by the removal of cefazolin from the recent government procurement list regardless of the recommendation set in the national EML and STG. This study found a historic shortage of cefazolin in Ethiopian healthcare settings. This implies that the antibiotic availability in the pull market may not reflect required usage at facilities for several reasons including the misalignment of national guidelines and national procurement processes, and miscommunication between pharmacies and clinicians at sites on drug availability. Changing the essential medicines list and/or procurement requests without active review of the supply chain system and prescribing practices at facilities can lead to the elimination of necessary antimicrobial agents from the national public health sector supply.
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Affiliation(s)
- Getachew Alemkere
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asres Teshome
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gobezie Temesgen
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Abebe
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yidnekachew Degefaw
- Antimicrobial Resistance Prevention and Control Case Team, Pharmaceuticals and Medical Equipment Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Hiwot Tilahun
- Department of Surgery, Gimjabet Primary Hospital, Gimjabet, Amhara, Ethiopia
| | - Workineh Getahun
- Antimicrobial Resistance and Global Partnership, USAID Medicines, Technologies, and Pharmaceutical Services Program, Management Sciences for Health, Addis Ababa, Ethiopia
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Department of Infectious Diseases, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Patel PK, Satoh N, Narita M, Cho Y, Oshiro Y, Suzuki T, Fowler KE, Greene MT, Tokuda Y, Kaye KS. Inpatient antibiotic prescribing patterns using the World Health Organization (WHO) Access Watch and Reserve (AWaRe) classification in Okinawa, Japan: A point-prevalence survey. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e155. [PMID: 36483349 PMCID: PMC9726586 DOI: 10.1017/ash.2022.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 06/17/2023]
Abstract
Using point-prevalence methodology and the World Health Organization (WHO) Access, Watch, and Reserve Classification, we measured antibiotic use in 5 hospitals in Okinawa, Japan, on October 1, 2020. Overall, 29% of patients were prescribed an antibiotic on the survey date and the 3 most used antibiotics in the "Watch" category were cefazolin, ampicillin-sulbactam, and ampicillin.
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Affiliation(s)
- Payal K. Patel
- Division of Infectious Diseases, Veterans’ Affairs Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan, United States
| | - Naoyuki Satoh
- Division of Hospital Medicine, Heartlife Hospital, Okinawa, Japan
| | - Masashi Narita
- Division of Infectious Diseases, Okinawa Chubu Hospital, Okinawa, Japan
| | - Yoshiaki Cho
- Division of Pediatric Infectious Diseases, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Okinawa, Japan
| | - Yusuke Oshiro
- Division of Hospital Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Tomoharu Suzuki
- Division of Hospital Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Karen E. Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - M. Todd Greene
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching Hospitals, Okinawa, Japan
| | - Keith S. Kaye
- Division of Infectious Diseases, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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12
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Miyamori D, Kamitani T, Kashiyama S, Ito M, Ohge H, Yamamoto Y. Bacterial susceptibility change post national shortage of first cephalosporin in Japan; a longitudinal retrospective database study using interrupted time series analysis. J Glob Antimicrob Resist 2022; 30:348-353. [PMID: 35732262 DOI: 10.1016/j.jgar.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The clinical evidence for the impact of narrow-spectrum antimicrobial shortages on bacterial susceptibility is limited. Our purposes were to determine the impacts of the disruption of most of the Cefazolin (CEZ) supply in Japan on the susceptibility of pathogens and to analyze how long these changes persisted after the shortage of CEZ. METHODS We performed an interrupted time series analysis using the Japanese Infectious Disease Nationwide database. We analyzed each pathogen before and after CEZ shortage in 52 university hospitals from 2018 to 2020. May to November 2019 was designated as the implementation term for CEZ shortage. The primary outcome was the susceptibility to CEZ and other antimicrobial agents. Among all pathogens isolated from facilities, we identified pathogens that were tested for susceptibility to CEZ. RESULTS Of the 26 pathogens identified, analysis was performed on a total of 36346 isolates of five pathogens (E.coli, K.pneumoniae, K.oxytoca, P.mirabillis, S.aureus). Among four gram negative pathogens with low susceptibility, there were no significant immediate changes after the CEZ shortage, however, the slope change significantly increased by 1.29-2.69% per month and continued to improve 1 year after the shortage. Regarding S. aureus, which was highly susceptible at the baseline, neither immediate change nor slope was significant. CONCLUSIONS This quasi-experimental analysis using nationwide large database revealed that restriction of use due to narrow antimicrobial shortages may lead to improved susceptibility over the subsequent year. The results suggest that temporary switching of antimicrobial agents on a national scale could be effective.
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Affiliation(s)
- Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital
| | - Tsukasa Kamitani
- Section of education for clinical research, Kyoto University Hospital
| | - Seiya Kashiyama
- Section of Clinical Laboratory, Department of Clinical Support, Hiroshima University Hospital
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital
| | - Hiroki Ohge
- Department of Infectious disease, Hiroshima University Hospital
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University.
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Effects of infectious disease consultation and antimicrobial stewardship program at a Japanese cancer center: An interrupted time-series analysis. PLoS One 2022; 17:e0263095. [PMID: 35077523 PMCID: PMC8789186 DOI: 10.1371/journal.pone.0263095] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/11/2022] [Indexed: 12/15/2022] Open
Abstract
In cancer patients, appropriate diagnosis and management of infection are frequently challenging owing to subtle or atypical presentation. We investigated the effectiveness of infectious disease (ID) consultations and the Antimicrobial Stewardship Program (ASP) in a Japanese cancer center. This 36-month-period, single-institution, interrupted time series analysis was retrospectively conducted during April 1, 2018–March 31, 2021, to evaluate a two-phase intervention: Phase 1 (notification of antimicrobials by the infection control team) and Phase 2 (establishing an ID consultation service and implementing ASP). Among 32,202 patients hospitalized, 22,096 and 10,106 hospitalizations occurred at baseline and during intervention period, respectively. The Antimicrobial Stewardship Team (AST) provided feedback on specific broad-spectrum antimicrobials in 913 instances (347 appropriate [38%]; 566 inappropriate [62%]), and 440 ID consultations were completed, with a 75% overall acceptance rate for AST suggestions. In Phase 2, monthly carbapenem days of therapy (CAR-DOT) decreased significantly, and narrow-spectrum antibiotic usage increased significantly in both trend and level; monthly DOT of antipseudomonal agents decreased significantly in trend. The results of these analyses of antimicrobial use are consistent with the DOT-based data based on antimicrobial use density (AUD). The total number of inpatient specimens increased significantly; the trend of multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus infections decreased, without changes in the incidence of other resistant organisms, all-cause in-hospital mortality, and length of stay. Actual and adjusted CAR purchase costs per patient-day decreased without significant changes in the actual and adjusted purchase cost per patient-day for all intravenous antimicrobials. Combining ID consultation and ASP reduced carbapenem use without negative patient outcomes. Their implementation could facilitate establishment of safe cancer treatment facilities in Japan and improve prognosis in cancer patients.
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Gu Y, Fujitomo Y, Ohmagari N. Outcomes and Future Prospect of Japan's National Action Plan on Antimicrobial Resistance (2016-2020). Antibiotics (Basel) 2021; 10:antibiotics10111293. [PMID: 34827231 PMCID: PMC8614776 DOI: 10.3390/antibiotics10111293] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 01/21/2023] Open
Abstract
The threat from antimicrobial resistance (AMR) continues to grow. Japan’s National Action Plan on Antimicrobial Resistance, which was formulated in 2016 and targets six areas, has already had a major impact on the countermeasures implemented against AMR. Particular advances have been made in AMR-related surveillance, and we now know the situation regarding antimicrobial use and antimicrobial-resistant bacteria in the country. Educational and awareness-raising activities for medical professionals and the general public have been actively implemented and seem to have contributed to a gradual move toward an appropriate use of antimicrobials. However, there is still insufficient understanding of the issue among the general public. Determining how to use surveillance results and implementing further awareness-raising activities are crucial to address this. Tasks for the future include both raising awareness and the promotion of AMR research and development and international cooperation. The government’s next Action Plan, which will detail future countermeasures against AMR based on the outcomes of and tasks identified in the current Action Plan, has been delayed due to the COVID-19 pandemic and is urgently awaited.
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Affiliation(s)
- Yoshiaki Gu
- Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- Correspondence: ; Tel.: +81-3-5803-4138
| | - Yumiko Fujitomo
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo 162-8655, Japan; (Y.F.); (N.O.)
| | - Norio Ohmagari
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo 162-8655, Japan; (Y.F.); (N.O.)
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo 162-8655, Japan
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15
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Koizumi R, Kusama Y, Asai Y, Yoshiaki G, Muraki Y, Ohmagari N. Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials. BMC Health Serv Res 2021; 21:1118. [PMID: 34663315 PMCID: PMC8523201 DOI: 10.1186/s12913-021-07139-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/05/2021] [Indexed: 01/01/2023] Open
Abstract
Background Shortages of antimicrobials lead to treatment failures, increase medical costs, and accelerate the development of antimicrobial resistance. We evaluated the effects of the serious cefazolin shortage in 2019 in Japan on the sales, costs, and appropriate use of other antimicrobials. Methods We evaluated monthly defined daily doses/1000 inhabitants/day (DID) values of antimicrobial sales from January 2016 to December 2019 using wholesaler’s sales databases. Using 2016–2018 sales data, we generated a prediction model of DID in 2019 under the assumption that the cefazolin shortage did not occur. We then compared the predicted DID and actual DID. Cefazolin, government-recommended alternatives, and government-not-recommended broad-spectrum alternatives were assessed. Antimicrobial groups according to the AWaRe classification were also assessed to evaluate the effect on appropriate antimicrobial use. In addition, we evaluated changes in costs between 9 months before and after the cefazolin shortage. Results DID values of total antimicrobials increased sharply 1 month before the decrease in cefazolin. Actual DIDs were higher than predicted DIDs for ceftriaxone, flomoxef, clindamycin, cefotiam, piperacillin/tazobactam, and meropenem. Actual DID values were higher than the predicted DID values in the Watch group. The costs of antimicrobials between pre- and post- cefazolin shortage were unchanged. Conclusion The cefazolin shortage brought confusion to the antimicrobial market and led to a setback in the appropriate use of antimicrobials. Early recognition and structures for prompt reactions to antimicrobial shortages are needed. Moreover, development of a system to secure the supply of essential antimicrobials is required. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07139-z.
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Affiliation(s)
- Ryuji Koizumi
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan. .,Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.
| | - Yusuke Asai
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Gu Yoshiaki
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.,Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.,Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
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16
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Uda A, Onuma K, Shigemura K, Kitagawa K, Yan Y, Osawa K, Yano I, Miyara T. Impact of Cefazolin Shortage on Clinical Outcomes of Adult Patients with Bacteremia Caused by Methicillin-Susceptible Staphylococcus aureus in a Tertiary Care University Hospital. Antibiotics (Basel) 2021; 10:antibiotics10101247. [PMID: 34680827 PMCID: PMC8532967 DOI: 10.3390/antibiotics10101247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
Cefazolin is an essential antibiotic used for treating bacteremia; in particular, it is recommended as a first-line agent for infections caused by methicillin-susceptible Staphylococcusaureus (MSSA). In March 2019, problems with a major antibiotic supplier caused a critical shortage of cefazolin in Japan; however, the impact of the cefazolin shortage on clinical outcomes remains unknown. This study aimed to evaluate the effect of the cefazolin shortage in patients with MSSA bacteremia. Data from 75 patients were compared between the pre-shortage (March 2018–January 2019, n = 39) and post-shortage (March 2019–January 2020, n = 36) periods. There were no significant differences in the demographic characteristics between the two groups, and the cefazolin shortage did not worsen clinical outcomes such as adverse drug reactions, treatment failure, and 30-day mortality. In the post-shortage group, ampicillin/sulbactam and benzylpenicillin were more frequently administered as alternative antibiotics for empirical and definitive therapy (10% vs. 31%, p = 0.042; 0% vs. 19%, p = 0.004, respectively). Multivariate analysis revealed that the broad-spectrum antibiotics for definitive therapy, such as antipseudomonal penicillin, were associated with treatment failure in patients with MSSA bacteremia (OR = 17, p = 0.003). Hence, narrow-spectrum antibiotics should be prescribed for MSSA bacteremia as alternatives during a cefazolin shortage.
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Affiliation(s)
- Atsushi Uda
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan;
- Correspondence: ; Tel.: +81-78-382-5111
| | - Kenichiro Onuma
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Department of Clinical Laboratory, Kobe University Hospital, Kobe 650-0017, Japan
| | - Katsumi Shigemura
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Koichi Kitagawa
- Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Division of Advanced Medical Science, Kobe University Graduate School of Science, Technology and Innovation, Kobe 657-8501, Japan
| | - Yonmin Yan
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Kayo Osawa
- Department of Medical Technology, Kobe Tokiwa University, Kobe 653-0838, Japan;
| | - Ikuko Yano
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan;
| | - Takayuki Miyara
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
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Valiulin SV, Onischuk AA, Baklanov AM, Dubtsov SN, An'kov SV, Shkil NN, Nefedova EV, Plokhotnichenko ME, Tolstikova TG, Dolgov AM, Dultseva GG. Aerosol inhalation delivery of cefazolin in mice: Pharmacokinetic measurements and antibacterial effect. Int J Pharm 2021; 607:121013. [PMID: 34419591 DOI: 10.1016/j.ijpharm.2021.121013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/26/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022]
Abstract
Aerosol inhalation delivery of cefazolin, a broad-spectrum first-generation cephalosporin antibiotic, was investigated. Inhalation system based on ultrasonic nebulizer was developed for the generation of dry cefazolin aerosol within mean particle diameter range 0.5-3.0 μm and mass concentration 0.01-3 μg/cm3. Pharmacokinetic measurements were carried out for the aerosolized form of cefazolin delivered in mice using nose-only chamber. Cefazolin concentrations in blood serum and in the lungs of mice were measured as a function of time by means of high performance liquid chromatography. Body-delivered dose depending on particle size, concentration and inhalation time as well as other pharmacokinetic parameters were determined. The antibacterial effect of aerosolized cefazolin was assessed through the aerosol inhalation treatment of mice infected with Klebsiella pneumoniae. Survival rate for infected mice after the treatment with cefazolin aerosol demonstrated high antibacterial efficiency of the inhalation delivery of cefazolin in comparison with intraperitoneal delivery.
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Affiliation(s)
- S V Valiulin
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, Novosibirsk, 630090, Russia
| | - A A Onischuk
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, Novosibirsk, 630090, Russia
| | - A M Baklanov
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, Novosibirsk, 630090, Russia
| | - S N Dubtsov
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, Novosibirsk, 630090, Russia
| | - S V An'kov
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, Novosibirsk, 630090, Russia; Vorozhtsov Institute of Organic Chemistry SB RAS, Novosibirsk 630090, Russia
| | - N N Shkil
- Siberian Federal Scientific Center of Agro-Biotechnologies RAS, Krasnoobsk 630501, Russia
| | - E V Nefedova
- Siberian Federal Scientific Center of Agro-Biotechnologies RAS, Krasnoobsk 630501, Russia
| | - M E Plokhotnichenko
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, Novosibirsk, 630090, Russia
| | - T G Tolstikova
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, Novosibirsk, 630090, Russia; Vorozhtsov Institute of Organic Chemistry SB RAS, Novosibirsk 630090, Russia
| | - A M Dolgov
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, Novosibirsk, 630090, Russia
| | - G G Dultseva
- Voevodsky Institute of Chemical Kinetics and Combustion SB RAS, Novosibirsk, 630090, Russia
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Shukar S, Zahoor F, Hayat K, Saeed A, Gillani AH, Omer S, Hu S, Babar ZUD, Fang Y, Yang C. Drug Shortage: Causes, Impact, and Mitigation Strategies. Front Pharmacol 2021; 12:693426. [PMID: 34305603 PMCID: PMC8299364 DOI: 10.3389/fphar.2021.693426] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Fatima Zahoor
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Sumaira Omer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi’an, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
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Kakkar AK, Shafiq N, Malhotra S. Cefazolin Shortages in the Developing World: The Same, But Different Too. Clin Infect Dis 2021; 72:1293-1295. [PMID: 32579180 DOI: 10.1093/cid/ciaa847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Beraud G. Shortages Without Frontiers: Antimicrobial Drug and Vaccine Shortages Impact Far Beyond the Individual! Front Med (Lausanne) 2021; 8:593712. [PMID: 33644090 PMCID: PMC7906993 DOI: 10.3389/fmed.2021.593712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Among increasingly common drug shortages, antimicrobial drug and vaccine shortages are the most frequently reported. This could be related to the smaller size of the market, compared to statins or antidepressant drugs. But there are multiple causes to shortages, such as flawed manufacturing processes, modification of quality control processes and scarcity of raw materials. Besides, concentration of manufacturing in emerging economies, dependence on a single producer and pressure on profit margins amplify the consequences of any manufacturing problem. Antimicrobial drug shortages have an impact on patient outcomes and antimicrobial resistance (AMR) by leading to choices of alternatives with an inadequately large spectrum, and consequently with deleterious side effects and increased costs. Moreover, vaccine shortages result in controversies exacerbated by the antivax community. Given the transmissibility of infectious diseases, antimicrobial drug and vaccine shortages will impact both individual and population health through herd effect. For these reasons, they represent a worldwide threat that goes beyond impact at the individual level. There has been no coordinated response to this threat hitherto. In order to provide an adequate response plan, precise data on shortage occurrences and their causes are a prerequisite. Moreover, efficient action will not be possible without a transnational will. Examples of useful actions could be: Incorporating a standardized survey into the WHO surveillance programs on antimicrobial use; creating a communication channel between pharmaceutical companies, providers and national agencies so as to recognize upcoming shortages; licensing some laboratories to manufacture out-of-stock drugs, for the duration of the shortage.
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Affiliation(s)
- Guillaume Beraud
- Infectious Diseases Department, University Hospital of Poitiers, Poitiers, France
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