Pharmacists Help Improve HIV Patient Outcomes During Drug Shortage

New research suggests that pharmacist collaboration with physicians during a national shortage of intravenous (IV) trimethoprim/sulfamethoxazole (TMP/SMX) may have helped mitigate negative treatment outcomes among HIV-infected patients with Pneumocystis jirovecii pneumonia (PJP).

Researchers from the University of New Mexico College of Pharmacy retrospectively compared outcomes between HIV-infected adult patients treated for PJP before and after the national IV TMP/SMX shortage, which occurred when the medication’s lone manufacturer halted its production from June 2010 to June 2013. The investigators also looked for differences among the PJP treatments used before and after the shortage.

The pre-shortage group included HIV patients treated at the University of New Mexico Hospital (UNMH) for PJP between September 1, 2008, and May 30, 2010, when IV TMP/SMX was available, while their post-shortage counterparts had been treated at the hospital between June 1, 2010 and June 30, 2012, when the medication was not available.

The investigators noted that current clinical guidelines recommend IV TMP/SMX as first-line therapy for moderate-to-severe PJP in HIV patients, but only 72% of those in the post-shortage group were treated with the medication, even after excluding patients with a TMP/SMX allergy.

According to the researchers, 3 patients in the pre-shortage group and 6 patients in the post-shortage group experienced PJP treatment failure defined as worsening respiratory function or lack of improvement after at least 4 to 8 days of PJP treatment. All except 1 of the treatment failures in the post-shortage group occurred between June 2010 and November 2010, so “while the lack of IV TMP/SMX may have led to poor treatment outcomes immediately following the shortage, this trend leveled off after 6 months,” the authors wrote.

The researchers attributed those improvements to increased pharmacist and physician awareness of the shortage, especially after “UNMH infectious diseases-trained pharmacists led an educational campaign to ensure that oral doses of TMP/SMX met the recommended 15-20 mg/kg/day of TMP and to inform clinicians of alternatives to IV TMP/SMX.”

Thus, the authors concluded, “pharmacist-led educational interventions along with more frequent use of PJP chemoprophylaxis and antiretroviral therapy may have helped mitigate the impact of this drug shortage on HIV-infected patient treatment outcomes when IV TMP/SMX was not available.”