Drug Availability

 

Further to DrugAlert Volume 336, HPS Pharmacies wish to give notice that Sandoz Australia are continuing to experience unstable stock levels of PiperTaz® Sandoz as follows:

PiperTaz® Sandoz Injection
 Piperacillin (as sodium) 4g and tazobactam (as sodium) 0.5g powder for injection bottle
ARTG 140840

This supply issue is due to an explosion at one of only two manufacturing sites globally of the active pharmaceutical ingredients. Continuity of supply has therefore, been a challenge for all suppliers both locally and globally.

Sandoz has an issue with the allocation of active pharmaceutical ingredient for the first quarter of 2018. Projections based on current utilisation rates suggest that continuity of supply will be maintained throughout 2017. However, to ensure continuity of supply during the first quarter of 2018, some stock control measures will be implemented. Wholesalers have already imposed limitations on PiperTaz® supply based on historic monthly volumes for each account holder.

In addition, Sandoz is working closely with the TGA and other stakeholders to identify appropriate alternatives to PiperTaz® Sandoz. This process involves clear identification of indications where no suitable clinical alternative exists and identification of indications with clinically appropriate alternatives. Suppliers of alternative products will be consulted to ensure they can absorb any incremental increase in demand.

The following table demonstrates some possible alternatives that may be considered. Specialist advice from an Infectious Diseases physician is recommended for individual patients.

Indication

Alternative Regimen

Pseudomonal Infections
(including Pseudomonal pneumonia)

Ceftazidime 2g IV 8-hourly

Biliary and intra-abdominal infections

Ceftriaxone 1g IV 24-hourly, PLUS
Metronidazole 500mg IV 12-hourly

If a patient has specific cardiac conditions (such as prosthetic cardiac valve, previous endocarditis, rheumatic heart disease),

ADD Ampicillin 2g IV 8-hourly (for enterococcal cover)

Diabetic foot infections
(where IV antibiotics are required)

Cefazolin 2g IV 8-hourly, PLUS

Metronidazole 500mg IV 12-hourly

Or for diabetic foot infections where enteric Gram-negative cover is required:

Ceftriaxone 2g IV 24-hourly, PLUS
Metronidazole 500mg IV 12-hourly

If Pseudomonas cover is required, please discuss with an Infectious Diseases physician.

Febrile Neutropenia

Cefepime 2g IV 8-hourly (with dose reductions in renal impairment)
+/- Metronidazole 500mg IV 12-hourly (if greater anaerobic cover is required)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Retain this notice in a prominent position, including in other related business units until supplies return to normal. Report any problems identified with medicines, vaccines or medical devices to the TGA.

Should you require further information regarding this matter, please contact your pharmacist at HPS Pharmacies, or Sandoz Australia on 1800 726 369.

References:

  1. Antibiotic Expert Group. Therapeutic Guidelines: Antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2017.
  2. Rossi S, editor. Australian Medicines Handbook 2017 (online). Adelaide: Australian Medicines Handbook Pty Ltd; 2017 July.
  3. St Vincent’s Private Hospital Melbourne Antimicrobial Stewardship Team. Memo: PiperTaz Shortage. Melbourne: St Vincent’s Health; 2017.

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