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By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON
(AP) - Hospitals nationwide are rationing adult tetanus
shots, reserving them for burn victims and other severely
injured patients, because of a huge shortage of the crucial
vaccine.
It's
one of the worst drug shortages facing hospitals in years
- and don't expect it to be the last. Shortages of medications
that hospitals use every day are occurring with more frequency,
and worse, they more often involve products with few good
alternatives.
While
experts can't point to a shortage that has cost a life,
it's a possibility that haunts doctors and pharmacists struggling
to cope.
``It's
really hard to talk about rationing care,'' said Linda Tyler,
pharmacy manager at the University of Utah Hospital. The
hospital hasn't offered adult tetanus booster shots since
fall, reserving scarce doses for high-risk patients with
burns, infected wounds or other severe trauma.
``We
use it 'til it's gone, and when it's gone, it's gone,''
she said.
So far
the tetanus crisis concerns only adult versions of tetanus
vaccine, not children's vaccine. But Centers for Disease
Control and Prevention (news - web sites) experts are watching
closely to see if the shortage spreads - and worrying about
adult illnesses this spring, when vaccine demand rises along
with a seasonal jump in injuries.
Supplies
already were tight because of production difficulties when
Wyeth-Ayerst Laboratories last month stunned hospitals by
suddenly ceasing to make the vaccine altogether, calling
it ``a business decision.''
CDC
praises the sole remaining manufacturer - Aventis Pasteur
- for working around the clock to brew more of the millions
of doses needed annually. But each batch takes 11 months
to make, so relief isn't expected before year's end.
It's
not the only shortage. Abbott Laboratories has run out of
lifesaving intravenous Isuprel, kept on hospital ``crash
carts'' to revive cardiac arrest victims, because of a problem
with its ingredient supplier. Doctors are using workable
but somewhat less desirable alternatives.
Eye
surgeons are stretching final supplies of Wydase, important
in numbing eyes for cataract and other surgeries after Wyeth
abruptly quit making it, too.
Also
in short supply is the powerful painkiller fentanyl, and
Narcan, used to reverse morphine overdoses.
``We
call and beg and plead'' for doses, said Carla Gill, associate
director of the Johns Hopkins Hospital pharmacy. ``We get
dribs and drabs of what we've ordered,'' and pharmacists
then furiously work to stretch supplies and find alternatives.
Nobody
keeps good statistics, but the nation's largest hospitals
and the Food and Drug Administration (news - web sites)
agree shortages - lasting from weeks to months at a time
- are increasing from a few critical drugs a year to about
a dozen.
Why?
Sometimes a company's ingredient supplier quits making a
key ingredient, or demand temporarily spikes.
Sometimes
FDA discovers health-threatening violations in a factory
and temporarily halts production - partly to blame for last
fall's flu vaccine shortage.
Some
manufacturers decide a product is not profitable enough.
With increasing drug company mergers, there are fewer competitors
making the same medicines anymore and thus fewer that can
quickly pick up the slack.
Companies
are notoriously tightlipped in explaining shortages. Take
Wyeth, which cites only ``manufacturing-related issues''
in killing Wydase, made in a factory FDA had cited for repeated
violations.
Shortages
encourage price-gouging, sometimes doubling, says Hopkins'
Gill who, a day after the Wydase announcement got a call
from a distributor with a stockpile looking to make a deal.
Hospitals
are feeling shortages sooner than ever before because, faced
with steep medication costs, most now keep only a few days'
supply in inventory.
The
FDA and CDC are studying which critical drugs are most at
risk for shortages, and FDA officials are trying to ease
the situation by finding overseas ingredient suppliers or
encouraging small drug companies to make a larger competitor's
castoff.
But
to help hospitals cope fast, Utah's Tyler is working with
the American Society of Health System Pharmacists to issue
Internet bulletins warning of impending shortages and listing
any alternatives.
What's
next? Tyler is warily watching whether a medicine crucial
for heart surgery that's now on backorder will turn into
a real shortage. ``It's put us in a panic. ... If we're
unable to get protamine, we'll have to think about canceling
surgeries that aren't emergencies,'' she said.
``This
is a tremendous headache,'' she added, and it's only going
to get worse.
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