Are security stores the answer to antibiotics shortages?

Set up national storage facilities for antibiotics, to solve problems with shortages of these vital drugs in hospitals. The suggestion comes from the collaboration platform PLATINEA. Håkan Hanberger, professor in infectious diseases, is one of the forces behind PLATINEA, and has long been active in the issue of antibiotic management.

Pharmacist holding medicine box and capsule pack in pharmacy drugstore.An expert group has proposed that Sweden should introduce national safety stores to cope with supply problems of antibiotics. Photo credit MJ_Prototype

The debate about antibiotics has often concerned the development of resistant bacteria and the need to develop new types of antibiotic. But we are facing other challenges with these vital drugs. One of these is their availability, or rather their lack of availability. 

Antibiotics are among the drugs most often placed on back order, according to the Medical Products Agency. Deficient availability has had a negative impact on medical care on many occasions.

LiU professor Håkan Hanberger was involved in establishing PLATINEA (the platform for innovation of existing antibiotics), which is a collaboration platform that unites the healthcare system, academia, government agencies and the pharmaceuticals industry. He is responsible for work within the PLATINEA project investigating how to improve the availability of important antibiotics in Sweden. The platform has just published its first report, in which it has investigated problems with the supply of antibiotics for inpatient care.

“It’s been like this for several years, and the problem is still not solved. We assess the situation as so acute that we recommend a rapid solution, and the establishment of national security stores”, says Håkan Hanberger, professor in the Department of Biomedical and Clinical Sciences (BMV), and senior consultant in infectious diseases at Linköping University Hospital.

Certain groups at higher risk

When the supply of antibiotics is interrupted, patients who are allergic to penicillin are hit particularly hard, since the treatment alternatives available for them are already limited. The report points out that pregnant women, children and the chronically ill are those first affected.Håkan Hanberger Photo credit John Karlsson

“We have fewer treatment alternatives for pregnant women and children, since several antibiotics can harm the growing foetus and children. The chronically ill who have been through several courses of antibiotic treatment are often hit by infections of bacteria that are resistant to the standard drugs. In such cases, we have to use fall-back alternatives”, says Håkan Hanberger.

His role as a doctor working in infectious diseases involves overall responsibility for antibiotics recommendations within Region Östergötland. He is often alerted to deficiencies in the supply of several antibiotics. When a deficiency arises, he is one of the doctors responsible for suggesting alternatives, and the problems are often acute during public holidays. The most recent example arose during the Xmas and New Year period we have just had.

“Deficiencies in the supply of antibiotics can be compared with deficiencies in bed places. It disrupts the work of healthcare personnel when they must spend time solving problems with drug supply, rather than spending time in the care and treatment of the patients. And it may be so that the alternative drugs that we have to use are not as effective, have an unnecessarily broad spectrum that affects much of the normal bacterial flora in the body, or give more undesired effects”, says Håkan Hanberger.

A vulnerable system

The members of PLATINEA have together identified several risk factors that affect the availability of antibiotics. Once the patent that covers a drug has expired, its sale becomes less profitable, which means that suppliers tend to remove the product from the Swedish market to a greater extent.

“The value of antibiotics whose patent has expired is underestimated in the current business models. The single-use equipment needed to administer an antibiotic directly into the bloodstream of a patient receiving inpatient care can cost more than the antibiotic itself. Antibiotics are so cheap that the slightest disturbance in the supply chain leads to companies choosing not to offer them to the Swedish healthcare system”, says Håkan Hanberger.Researchers at Linköping University studies bacteria resistant to different antibiotics. Photo credit Thor Balkhed

The Public Health Agency of Sweden has been commissioned by the government to investigate several models to reduce the risk for supply problems. The agency is planning to undertake a pilot study to test a proposed system with fixed annual remuneration to suppliers of particular antibiotics for hospital use that are still under patent protection and are of particular medical value. This trial, however, does not include older antibiotics, which constitute by far the majority of antibiotics used in Sweden placed on back order.

In its first report, PLATINEA suggests that Sweden introduce a national coordinated security store for inpatient care, in which the antibiotics in storage are continuously turned over.

“It would have been possible to avoid most of the situations in which drug supply was interrupted in recent years if we had had a store like this. The goal is to increase the rate of flow, volumes and availability of antibiotics along the complete chain of distribution, from the wholesalers that import the drugs, to the storage on an individual ward”, says Håkan Hanberger.

Thus, it is not a case of emergency stores of the type set up to cope with a crisis, but security storage to be used in normal conditions to increase the availability of antibiotics and to act as a buffer in the system.

Innovations must work in the real world

The report also suggests changes intended to strengthen the chain of delivery by obtaining the same drug from several suppliers, and it suggests financial models that give pharmaceuticals companies higher incentives to secure the supply of antibiotics. Håkan Hanberger points out that it is important that innovations in the system of antibiotic supply are worked out in collaboration with the commercial actors.

“What makes it possible for PLATINEA to give concrete suggestions for innovations that improve the availability of antibiotics is its broad expertise. It has representatives for the pharmaceuticals industry, government agencies, the healthcare system, and medical research, together with researchers within business management.”

Håkan Hanberger hopes that PLATINEA can contribute other ideas that will maintain the value of existing antibiotics for coming generations. The network may, for example, carry out analyses that other actors do not undertake, and design interventions that are needed to preserve the effect of antibiotics.

“PLATINEA can be a think tank, somewhere where ideas are brought forward to deal with deficiencies in the system for the supply of antibiotics”, says Håkan Hanberger.

Link to the report (in Swedish)

Translation by George Farrants

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