Critical National Shortage of Cefazolin in Japan: Management Strategies

Honda, Hitoshi; Murakami, Shuntaro; Tokuda, Yasuharu; Tagashira, Yasuaki; Takamatsu, Akane

doi:10.1093/cid/ciaa216

Cited by 28 publications

(31 citation statements)

References 22 publications

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“…In low-income countries, literature cited medicines used for TB, Malaria, and HIV due to the increased incidence of these diseases and the unavailability of essential drugs rather than drug shortages or stock-out. Table 1 shows the medicines affected by shortages in different countries (Elbagir et al, 1995;Kangwana et al, 2009;Tren et al, 2009;Ballinger, 2010;Ventola, 2011;Griffith et al, 2012;Liang and Mackey, 2012;Malik et al, 2013;Quilty, 2014;Ricci et al, 2016;Donohue and Angus, 2017;Gross et al, 2017;Hsueh et al, 2017;Meloni et al, 2017;Tan et al, 2017;Vail et al, 2017;Banerjee et al, 2018;Dave et al, 2018;Gundlapalli et al, 2018;Holcombe et al, 2018;Said et al, 2018;Benge and Burka, 2019;Visage et al, 2019;Yellapu et al, 2019;Benhabib et al, 2020;Choo and Rajkumar, 2020;Clark et al, 2020;Honda et al, 2020;Siow et al, 2020;Sun et al, 2020;Mclaughlin et al, 2017;Dave et al, 2018).…”

Section: Drugs Reported In Shortagementioning

confidence: 99%

Drug Shortage: Causes, Impact, and Mitigation Strategies

et al. 2021

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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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Section: Drugs Reported In Shortagementioning

confidence: 99%

Drug Shortage: Causes, Impact, and Mitigation Strategies

et al. 2021

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“…The actual DID values of the government-recommended alternatives ceftriaxone, flomoxef, clindamycin, and cefotiam were higher than their predicted DID values. It was suggested that drug makers increased the production of these drugs to alleviate damage caused by the cefazolin shortage; however, the production increases were insufficient to compensate for the cefazolin shortage, which led to secondary shortages among these drugs [ 19 ]. According to a questionnaire-based study, the cefazolin shortage caused considerable damage in the maintenance of quality-assured medicines in various hospitals [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Ministry of Health, Labour and Welfare of Japan published a list of alternative antimicrobials to cefazolin [ 17 ]; however, this caused secondary shortages among the alternative drugs [ 18 ]. Collapse of antimicrobial stewardship due to the cefazolin shortage has already been reported by a single center, and demonstrated the rapid increase in the use of third-generation cephalosporins after the cefazolin supply became limited [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials

Koizumi

Kusama

Asai

et al. 2021

BMC Health Serv Res

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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.

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“…The actual DID values of the government-recommended alternatives ceftriaxone, omoxef, clindamycin, and cefotiam were higher than their predicted DID values. It was suggested that drug makers increased the production of these drugs to alleviate damage caused by the cefazolin shortage; however, the production increases were insu cient to compensate for the cefazolin shortage, which led to secondary shortages among these drugs [21]. According to a questionnaire-based study, the cefazolin shortage caused considerable damage in the maintenance of quality-assured medicines in various hospitals [22].…”

Section: Discussionmentioning

confidence: 99%

Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials

Koizumi

Kusama

Asai

et al. 2021

Preprint

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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/1,000 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 non-government-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.

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Critical National Shortage of Cefazolin in Japan: Management Strategies

Cited by 28 publications

References 22 publications

Drug Shortage: Causes, Impact, and Mitigation Strategies

Drug Shortage: Causes, Impact, and Mitigation Strategies

Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials

Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials

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