Claus B, Bauters T, Laureys G
1 Pharmacy Department, Ghent University Hospital, Ghent, Belgium.
2 Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
J Oncol Pharm Pract. 2019 Jun;25(4):841-846. doi: 10.1177/1078155218765627. Epub 2018 Mar 29.
This article describes the implications of shortages of pharmaceutical products used in conditioning and supportive care regimens of pediatric patients undergoing a hematopoietic stem cell transplantation in a tertiary care hospital. Between July 2011 and July 2016, a total of 84 individual shortages, affecting 22 different drugs (79.8% supportive care drugs; 20.2% chemotherapeutics) were detected with a mean duration of 85 days (SD 138) per individual drug shortage. Eighteen shortages were critical and very urgent. Sulfamethoxazol/trimethoprim, piperacillin/tazobactam, ranitidine, benzylpenicillin, ondansetron (supportive care) and methotrexate, melphalan (chemotherapeutics) had the longest supply disruptions. A variety of solutions could be identified including the purchase of a generic alternative (36.9%) for both oral and parenteral treatments (in a ratio 3:2). Urgent import from another (European) country was performed in 14 cases (16.7%). High impact solutions such as cohorting of patients and change of ongoing treatments (2.4%) were used for parenteral treatments only. Pharmaceutical modification was sometimes applied for oral treatments (2.4%). Due to persistent occurrence of these shortages, an efficient pharmacy workflow (electronic follow-up by end of 2016) and a multidisciplinary approach were needed.
本文描述了一家三级护理医院中，造血干细胞移植儿科患者预处理和支持性护理方案中使用的药品短缺所带来的影响。2011年7月至2016年7月期间，共检测到84次个别药品短缺，涉及22种不同药物（79.8%为支持性护理药物；20.2%为化疗药物），每种药品短缺的平均持续时间为85天（标准差138）。其中18次短缺情况危急且非常紧急。磺胺甲恶唑/甲氧苄啶、哌拉西林/他唑巴坦、雷尼替丁、苄星青霉素、昂丹司琼（支持性护理药物）以及甲氨蝶呤、美法仑（化疗药物）的供应中断时间最长。可以确定多种解决方案，包括购买口服和注射用的通用替代品（占36.9%，口服与注射比例为3:2）。14例（16.7%）从另一个（欧洲）国家紧急进口药品。仅在注射用治疗中采用了患者分组和改变正在进行的治疗方案等高影响解决方案（占2.4%）。口服治疗有时会采用药物剂型调整（占2.4%）。由于这些短缺情况持续出现，需要一个高效的药房工作流程（到2016年底进行电子跟踪）以及多学科方法。
