• Impact of Amikacin National Drug Shortage on Aminoglycoside Prescribing and Drug Usage at an Academic Medical Center

      Matthias, Kathryn; O’Connor, Dalys; Matthias, Kathryn; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: The objective of this study was to compare the use of amikacin 1 year before the national drug shortage and 1 year during drug shortage in order to evaluate the impact of the drug shortage on prescribing amikacin at an academic medical center. Methods: All patients admitted to an academic medical center between January 1, 2008 to December 31, 2008 before the shortage and January 1, 2011 to December 1, 2011 during the shortage who were prescribed amikacin were evaluated. Data collected included demographic information, type of infection, aminoglycoside therapy prescribed, laboratory data, culture and susceptibility data, therapy outcomes, and potential complications of aminoglycoside therapy. Appropriateness of amikacin therapy was based on each subject’s clinical condition, culture and susceptibility results, and availability of an alternative antibiotic agent. The use of amikacin was considered inappropriate in subjects with Gram-negative organisms that had either tobramycin or gentamicin minimum inhibitory concentrations of less than or equal to 2 mcg/mL. Main Results: A total of 11 subjects in 2008 and 17 subjects in 2011 who were prescribed amikacin were evaluated. The median and range duration of amikacin therapy was 2.2 days and 0-17 days in 2008. In 2011, the median and range duration of amikacin therapy was 4.6 days and 0-38 days. In 2008 and 2011, 27% and 47% were subjects with cystic fibrosis and/or a history of solid organ transplant, respectively. In 2008 73% of amikacin orders were classified as appropriate while 59% of amikacin orders were classified as appropriate in 2011. Ototoxicity was reported in one subject who received amikacin in both 2008 and 2011. Conclusion: Despite restrictions for ordering amikacin implemented during a nationwide shortage, the percentage of appropriate orders for amikacin was lower during the shortage compared to before the shortage at an academic medical center.