Potential Consequences of Essential Drug Shortages in Canada: Brain Abscess due to Nocardia farcinica Associated with Dapsone Prophylaxis for Pneumocystis jirovecii Pneumonia

Abstract

In 2012, Canadian pharmacies experienced a shortage of trimethoprim-sulfamethoxazole tablets. Drug shortages may result in unintended clinical consequences such as infection with pathogens against which the alternative medication is ineffective. This is highlighted in the present article, which describes a case of brain abscess due to Nocardia species that developed while receiving dapsone as an alternative for prophylaxis against Pneumocystis jirovecii pneumonia in a highly immune-suppressed patient. Clinicians should be cognizant of these issues when prescribing alternative agents.

Unavailability of Outpatient Medications: Examples and Opportunities for Management

“…Unfortunately, most alternative agents have little or no activity against Nocardia species infections. 8 In France, a shortage in 2012 led to the substitution of 100 mg phenytoin with 100 mg phenytoin sodium. 9 The results of the substitution were detailed in a case series and included the following: hospitalizations, increases in epileptic attacks, memory issues, thymic disorders, and one death.…”

“…In 2012, the Canadian supply of trimethoprim-sulfamethoxazole (TMP-SMX) was jeopardized when 2 major manufacturers experienced backorders of the drug. 8 A case report detailed a highly immune-suppressed 54-year-old patient who developed a brain abscess from Nocardia after being switched to dapsone from TMP-SMX. Unfortunately, most alternative agents have little or no activity against Nocardia species infections.…”

Pénuries de médicaments au Canada au cours des 24 derniers mois : la situation ne fait que qu’empirer

“…Indépendamment de cette menace, le Canada fait déjà face à de nombreuses pénuries de médicaments au quotidien, en dépit d'une déclaration obligatoire de pénuries réelles ou anticipées imposée aux fabricants canadiens depuis 2017 5 . Plusieurs auteurs ont étudié la problématique des pénuries de médicaments au Canada [6][7][8][9][10][11][12][13] . Ces pénuries sont liées à de nombreuses raisons, dont des pénuries de matière première de médicaments et de fournitures associées à la production de médicaments, des problèmes de fabrication, des enjeux réglementaires liés à la conformité des lieux de production, des modalités de remboursement, etc.…”