Availability and Use of Therapeutic Interchange Policies in Managing Antimicrobial Shortages among South African Public Sector Hospitals; Findings and Implications

Abstract

Background: Therapeutic interchange policies in hospitals are useful in dealing with antimicrobial shortages and minimising resistance rates. The extent of antimicrobial shortages and availability of therapeutic interchange policies is unknown among public sector hospitals in South Africa. This study aimed to ascertain the extent of and rationale for dealing with antimicrobial shortages, describe policies or guidelines available, and the role of pharmacists in the process. Methods: A quantitative and descriptive study was conducted with a target population of 403 public sector hospitals. Data were collected from hospital pharmacists using an electronic questionnaire via SurveyMonkeyTM. Results: The response rate was 33.5% and most (83.3%) hospitals had experienced shortages in the previous six months. Antimicrobials commonly reported as out of stock included cloxacillin (54.3%), benzathine benzylpenicillin (54.2%), and erythromycin (39.6%). Reasons for shortages included pharmaceutical companies with supply constraints (85.3%) and an inefficient supply system. Only 42.4% had therapeutic interchange policies, and 88.9% contacted the prescriber, when present, for substitution. Conclusions: Antimicrobial shortages are prevalent in South African public sector hospitals with the most affected being penicillins and cephalosporins. Therapeutic interchange policies are not available at most hospitals. Effective strategies are required to improve communication between pharmacists and prescribers to ensure that safe, appropriate, and therapeutically equivalent alternatives are available.

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

“…Medicine shortages are an increasing concern across countries ( Acosta et al, 2019 ) and are a particular issue in Africa where typically up to 94% of its medicines are imported ( N Gage Consulting, 2017 ; Bavier, 2020 ; Dugmore, 2020 ), and supply issues can be exacerbated in countries with ongoing conflicts ( ALCED, 2020 ). However, African countries are already taking steps to address concerns with shortages before and during the pandemic including suggesting potential alternatives ( Chigome et al., 2019 ; Medical Brief, 2020b ; Modisakeng et al., 2020 ; Review Online, 2020 ; Tomlinson, 2020 ). There are also ongoing programmes to address the quality of medicines across Africa.…”

Practical Implications From European Hospital Pharmacists on Prospective Risk Assessment for Medicine Shortages

“…This can breed unfamiliarity with the dosing schedules, adverse-effect profiles, and treatment efficacy for therapeutic alternatives among healthcare workers ( 7 , 9 , 10 ). Concerns and unfamiliarity can be enhanced if therapeutic alternatives have not been agreed in advance ( 11 ).…”

“…As a consequence, medication errors caused by shortages need to be thoroughly documented, reviewed, analyzed, and reported as part of safety procedures ( 7 , 17 ). In addition, possible therapeutic substitutions need to be predetermined and categorized in order to avert potential harm, thereby providing the optimal treatment for a patient in these circumstances ( 8 , 11 , 18 ). A comprehensive risk assessment is the first step in planning for shortages as this allows for a review of all decision making processes in a healthcare setting where risks of patient harm stem from numerous aspects of treatment ( 19 , 20 ).…”

“…With medicine shortages on the rise ( 4 , 35 – 37 ), therapeutic substitution has become one of the most important steps in providing continuity of treatment to a patient ( 7 , 11 , 38 , 39 ). Its importance is not only constituted in the substitution itself, but that this process also represents high risk; as such, it may cause patient harm if not properly designed, implemented and regularly evaluated ( 7 ).…”

Formulary Management Activities and Practice Implications Among Public Sector Hospital Pharmaceutical and Therapeutics Committees in a South African Province

“…Access to and affordability of medicines is a challenge especially in low- and middle-income countries (LIMCs) including South Africa ( Cameron et al., 2009 ; Leisinger et al., 2012 ; Attaei et al., 2017 ; Wirtz and Moucheraud, 2017 ; Chigome et al., 2019 ). One way to address this is to improve the appropriate use of medicines, given that more than half of all medicines are prescribed or dispensed inappropriately with approximately half of all patients failing to take their medicines correctly ( World Health Organization, 2012 ; Ofori-Asenso and Agyeman, 2016 ).…”