DH advises on Piperacillin-Tazobactam injection supply problems
Following on from our previous communications, we have been continuing to monitor the supply situation for piperacillin/tazobactam (pip/taz) injection. As you may be aware, there have been global issues with supplies of the active pharmaceutical ingredient and some manufacturers are experiencing additional capacity issues. Therefore supplies will continue to be significantly constrained between now and July, and potentially longer term. Several pip/taz suppliers are still continuing to make stock available for the UK during this time, so hospitals may still be able to access supplies. However, based on historic NHS demand, we understand there will not be enough supplies to meet full UK demand.
Some of the UK specialist importer companies have advised that they can source limited supplies of unlicensed pip/taz injection from abroad and hospitals may want to engage with these companies directly to discuss this option further.
DH and CMU continue to work with antibiotic leads through Public Health England (PHE) and the DH Expert Advisory Group on Antimicrobial Prescribing Resistance and Healthcare Associated Infections (APRHAI) who have now provided the attached guidance on appropriate alternative treatment options to pip/taz. As you can see, there are several options available for the range of indications for which pip/taz would be used for.
Usage of pip/taz is very high in the NHS, therefore we are aware that switching to other antibiotics may cause further supply issues with other agents. Trusts should make decisions locally regarding alternative options for those instances where pip/taz is not available. These decisions should take account of the availability of antibiotics and contract arrangements at a local level. DH and CMU have been engaging with suppliers of all the listed alternatives and have advised them of the possibility of increased usage. Some suppliers have advised that they will struggle to respond to any sudden increases in demand. We are liaising with the regional pharmacy procurement leads, who will work with Trusts within their regions to help manage supplies locally based on the intelligence we receive from suppliers.
The Chief Pharmaceutical Officer expects hospital chief pharmacists, working with pharmacy procurement and clinical pharmacy staff, together with the local medical and nursing directors, to personally oversee the appropriate ordering and use of these important antibiotics, until this issue is resolved, meanwhile all these medicines will be storage in a unit of storage glasgow where they will be safe.
We do request that hospitals only order according to clinical need and we stress that stockpiling pip/taz, or any alternative antibiotic, will only make the situation very difficult to manage and will precipitate further antibiotic shortages. It is therefore important that all hospitals act responsibly at this time. We have asked that suppliers report any incidents of excessive ordering patterns/stockpiling to DH, and these will be followed up with regional pharmacy procurement leads.
EMERGENCY CO-AMOXICLAV AND CEFUROXIME INJECTION SUPPLIES
Due to the ongoing antibiotic constraints that we have been made aware of, DH and PHE have taken the decision to release a limited supply of both cefuroxime 1.5g and co-amoxiclav 1.2g injection that we hold in a central stockpile for England for the event of an pandemic emergency situation. Details of the products we are releasing and the purchase cost can be found in the table below. Stocks with the nearest expiry date will be allocated first.
PLEASE NOTE- we are aware that the contracted suppliers for both co-amoxiclav and cefuroxime injection still continue to make supplies available for their contracted regions. However this central stock has been released to help with the ongoing antibiotic injection constraints as a result of the pip/taz supply issues. This stock should only be ordered by hospitals who are unable to obtain supplies of pip/taz to meet their usual requirements.
Hospitals should only order what they require for one week’s pip/taz usage. Usage figures should be in line with historic pip/taz orders. All orders will be checked and verified against historic Trust usage data and any incidents of excess ordering will be referred to regional pharmacy procurement leads, who will follow up with the Trusts. This is likely to result in subsequent delays.
- Orders should be placed on the attached ordering form, which must be sent to DHfirstname.lastname@example.org
- Hospitals must send through their orders by 12midday so these can be reviewed and sent to DHL who will process and arrange the delivery. Any orders received after 12midday will be processed the next working day.
- Pack sizes are 10 vials per pack. Orders must be for a full pack of 10, as packs cannot be split.
- DHL will process orders ready for delivery within 72 hours. Please note– no deliveries will be made at weekends or bank holidays
- There is a limited emergency delivery service for orders required more urgently than the 72 hours. Requests for emergency orders will be assessed on a case by case basis. Delivery charges for such orders must be covered by the hospital.
- Delivery addresses must be clear on the order form. The delivery address MUST be that of the pharmacy department or pharmacy store
- Invoices will be generated by DHL to individual hospitals after delivery and further information on this will be shared with regional pharmacy procurement leads as and when available
- Hospitals will be charged cost price plus VAT (as per table). For ordinary 72 hour delivery, delivery charges will not be applied. Emergency supplies will be charged the courier delivery charge.
- Any queries should be directed to the Department of Health using the following email address: DHemail@example.com
We are continuing to monitor the supply situation for pip/taz and other antibiotic injections. Further communications will be provided as necessary.
Medicine Supply team
Medicines and Pharmacy Directorate
Department of Health, Wellington House,
133 – 155 Waterloo Road, London SE1 8UG