Impact of an Intravenous Trimethoprim/Sulfamethoxazole Shortage on Treatment Outcomes Among HIV-Infected Patients with Pneumocystis jirovecii Pneumonia

Dilworth, Thomas J; Ibrahim, Omar; Mercier, Renée-Claude

doi:10.18553/jmcp.2014.20.12.1246

Cited by 4 publications

(6 citation statements)

References 27 publications

(34 reference statements)

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“…One study, Abdelrahman et al [36] reported both increased and equivalent mortality, the majority of physicians agreed or were neutral regarding the statement that drug shortages resulted in patient deaths, however, there was also a proportion of physicians which disagreed. Medication classes that were commonly involved in poor patient outcomes during shortages included antimicrobials [28, 33, 37–39] and oncology medicines [24–27, 31, 32, 40–42].…”

Section: Resultsmentioning

confidence: 99%

“…Adverse drug reactions (ADRs) were reported in 24 studies. Of these, 14 reported increased ADRs [7, 13, 22, 22–26, 28, 33, 37, 38, 40, 43, 44], six reported equivalent incidences of ADRs [8, 31, 32, 35, 41, 45], and one reported decreased ADRs due to the shortages [16]. Three studies reported multiple impacts on ADRs.…”

Section: Resultsmentioning

confidence: 99%

“…Changes in hospitalisation status were reported in 11 studies. Of these seven studies reported increased hospitalisation [5, 13, 28, 29, 33, 37, 47], three reported equivalent hospitalisation [31, 35, 48], and one reported decreased hospitalisation [8].…”

Section: Resultsmentioning

confidence: 99%

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The impacts of medication shortages on patient outcomes: A scoping review

et al. 2019

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Background In recent years, medication shortages have become a growing worldwide issue. This scoping review aimed to systematically synthesise the literature to report on the economic, clinical, and humanistic impacts of medication shortages on patient outcomes. Methods Medline, Embase, Global Health, PsycINFO and International Pharmaceutical Abstracts were searched using the two key concepts of medicine shortage and patient outcomes. Articles were limited to the English language, human studies and there were no limits to the year of publication. Manuscripts included contained information regarding the shortage of a scheduled medication and had gathered data regarding the economic, clinical, and/or humanistic outcomes of drug shortages on human patients. Findings We found that drug shortages were predominantly reported to have adverse economic, clinical and humanistic outcomes to patients. Patients were more commonly reported to have increased out of pocket costs, rates of drug errors, adverse events, mortality, and complaints during times of shortage. There were also reports of equivalent and improved patient outcomes in some cases. Conclusions The results of this review provide valuable insights into the impact drug shortages have on patient outcomes. The majority of studies reported medication shortages resulted in negative patient clinical, economic and humanistic outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The impacts of medication shortages on patient outcomes: A scoping review

et al. 2019

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“…There was no increased mortality noted while the shortage lasted. 94 For patients with severe disease, however, IV therapy is preferred to improve the likelihood that appropriate serum levels of the drug will be attained. TMP-SMX is less well tolerated among patients with HIV/ AIDS than among those with other underlying diseases.…”

Section: Treatment Of Pneumocystis Pneumoniamentioning

confidence: 99%

Pneumocystis jirovecii Pneumonia in Human Immunodeficiency Virus Infection

Siegel

Masur

Kovacs

2016

Semin Respir Crit Care Med

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The presentation of Pneumocystis pneumonia (PCP) in previously healthy men having sex with men (MSM) in San Francisco and New York City in 1981 heralded the beginning of the human immunodeficiency virus (HIV) pandemic. Despite a decreasing incidence of PCP among patients with HIV/AIDS (acquired immunodeficiency syndrome) since the advent of combination antiretroviral therapy in the mid-1990s, PCP remains one of the most common AIDS-defining opportunistic infections in the United States and Western Europe. Newer molecular diagnostic tests in conjunction with standard immunofluorescent or colorimetric tests have allowed for more rapid and accurate diagnosis. Although several effective oral and intravenous therapies exist to treat PCP, mortality rates in HIV-infected individuals remain unacceptably high, especially in those with advanced AIDS. The identification of specific mutations in Pneumocystis genes targeted by trimethoprim-sulfamethoxazole has raised concerns about the development of resistance to the drug of choice and may ultimately lead to greater utilization of alternative therapies to treat PCP in the future.

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“…Finally, in a study of the impact of an intravenous trimethoprim/sulfamethoxazole shortage on treatment outcomes with Pneumocystis jirovecii pneumonia, Dilworth and colleagues found that more patients experienced treatment failure, worsening clinical status, and had slightly longer length of stay during the shortage as compared to the pre-shortage period. 9 It was suggested that, although the negative impact on patient outcomes was immediate, collaboration between pharmacists and physician caregivers improved outcomes and lessened the global impact of the shortage. The patient outcomes in this study are in contrast to our finding of a significantly decreased length of stay during the pre-shortage group and the findings of no difference between groups in length of therapy, days of therapy, and ICU status.…”

mentioning

confidence: 99%

Impact of piperacillin-tazobactam shortage on meropenem use: implications for antimicrobial stewardship programs

Barber

Bell

King

et al. 2016

The Brazilian Journal of Infectious Diseases

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Drug shortages pose a clear detriment to antimicrobial stewardship (AS) efforts. Our objective was to evaluate the effect of a piperacillin-tazobactam shortage on meropenem use, related costs, and associated changes in AS activity. A quasi-experimental quality improvement review compared adult patients receiving meropenem ≥72h three months pre-shortage and three months during the shortage. 320 patients were included (pre-shortage: 103; shortage: 217). Baseline characteristics were similar, but the length of stay was slightly longer in pre-shortage [19 (11-32) days] versus shortage [16 (11-32) days] (p=0.094). In pre-shortage and shortage, median days of therapy and estimated meropenem cost were 7 (5-11) and 7 (5-10) and $309.93 ($173.60-$507.03) and $255.30 ($204.24-$424.31), respectively (p=0.411 and p=0.050). Frequency of ID consultation was similar (16.8% in pre- and 25.3% in shortage, p=0.091). AS interventions increased during the shortage period (99 in pre-shortage and 205 in shortage). De-escalation occurred in 19.4% versus 32.7% of the patients in pre-shortage and shortage (p=0.014). The piperacillin-tazobactam shortage was associated with a 111% increase in meropenem prescriptions despite active AS, but was not associated with changes in mortality, length of therapy, or meropenem costs. AS should be aware that shortages may require proactive countermeasures to avoid inappropriate antimicrobial use during shortage periods.

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Impact of an Intravenous Trimethoprim/Sulfamethoxazole Shortage on Treatment Outcomes Among HIV-Infected Patients with Pneumocystis jirovecii Pneumonia

Cited by 4 publications

References 27 publications

The impacts of medication shortages on patient outcomes: A scoping review

The impacts of medication shortages on patient outcomes: A scoping review

Pneumocystis jirovecii Pneumonia in Human Immunodeficiency Virus Infection

Impact of piperacillin-tazobactam shortage on meropenem use: implications for antimicrobial stewardship programs

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