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How is your hospital addressing the Carbapenem shortage?

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tongiecc

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Hey guys! I'm sure your hospital is already experiencing challenges getting in any mero/dori/imi penem, what are you doing to get around this? Just rec alternative ABX? We have tried to stock some odd ready to mix minibags but have not been able to obtain a large supply. I contacted the purchaser of the academic med center that is the core member of our health system but haven't heard back (Friday). I'm not the DOP or charged with inquiring on this, but I'm just trying to help out by seeing what others are doing in the interim.

Thanks in advance for any responses! (Praziquantel? BMB? Confetti?, etc. would love to have your $0.02)
 

gwarm01

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I wasn't even aware there was a shortage. We have merrem on formulary, but don't use it too often. It's one of our restricted antibiotics, and anyone not meeting criteria is taken off.

We're struggling more with a shortage of Zosyn and Claforan honestly.
 
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tongiecc

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Thanks for the reply! We may be heading that way and are presently restricting and changing to Zosyn, etc. when appropriate, though it doesn't sound promising on the pip/taz front that you guys are seeing some difficulty getting it in. Can you buy the large vials (45gm I think?) and batch them manually as an option?
 

tongiecc

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And also to clarify, this does not appear to be (at least for now) a long term shortage, it may be more of a short term issue that is mainly with our wholesalers (though we use AB and MCK so I would think everyone would be experiencing at least some difficulties in the short term regardless of wholesaler, but I could be mistaken)
 

gwarm01

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That's actually what we have started doing. We had a supply of the 45 gram vials just sitting around, so we make big batches using them.
 
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PolarPop

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We haven't had any trouble yet but all the carbapenems are restricted at our hospital. No one can even order them except ID attendings or pharmacy so they are conserved pretty well.
 
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confettiflyer

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What the, geez another shortage.

We already have a pretty good stewardship program in place, tamping down on inappropriate escalation to cover supposed ESBL infections. We've been a little loose with our ICU docs lately, but we're working with ID to actively investigate carbapenem orders for appropriateness.

That's pretty much the primary way to handle this, IMO. All of the management happens on the empiric/initial abx selection. Assuming not every carbapenem is on shortage, you further triage within the class and save Merrem for your sz population, stuff like that.
 
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rxlea

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Get em in the ED. Unless they have a history or a very compelling reason to get a carbapenem, they are getting vanc/cef/flagyl. I stopped taking the "but my attending said that" BS from the interns.
 
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rxlea

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The other night an intern said "I just want something broad" .
 
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pillpharmer14

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Restricted for us as well with pretty strict criteria. cefepime + flagyl is my go to for replacing zosyn/merrem orders but it isn't always appropriate. It really depends on what you're treating.
 
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tongiecc

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Thanks for all the replies guys! Sounds like we should just be a bit more restrictive (we already are somewhat, but carbapenems aren't a focus area of our stewardship program so many patients are on that shouldn't be (primarily we attempt to limit Dapto/Zyvox/other high cost and of course de escalate off broad empiric coverage (vanc/zosyn, etc), but it looks like we should really just use this as an opportunity to clamp down on carbapenem ordering. Thanks again!
 
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xiphoid2010

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For zosyn, we've been able to get the 40.5gram ones, but obviously its a major PITA, change to cefepime+/-flagyl whenever possible. We still get a limited allocation of merrem. So for ESBL that you normally would tackle with merrem, amikacin has pretty low resistance here. Look to unasyn and minocycline for acinetobacter. Merrem if really needed, and Colistin as last resort.
 
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