In an accompanying editorial, experts noted that since September 2011, the supply of key second-line TB drugs has been "precarious."
"Kanamycin is no longer produced in the United States, streptomycin has been intermittently unavailable because of increased international demand, and capreomycin and amikacin have been available on an intermittent basis in only small amounts because of manufacturing problems and lack of raw materials," according to the editorial.
Other causes included shipping delays (noted in 71 percent of cases), lack of resources (62 percent), and the complicated process of obtaining certain drugs (48 percent).
As a result of difficulties obtaining drugs to treat multidrug-resistant TB, 58 percent of the TB programs reported delays in treating patients, 32 percent said there were lapses or interruptions in patient treatment, and 32 percent said they were forced to use an inadequate -- and potentially less effective -- treatment regimen.
Shortages disrupt the flow of care, as well, the editorial pointed out, leading to "rationing, increased drug costs, and inefficient use of staff time." They also "increase the risk for medication errors because regimens must be adjusted, leading to confusion over drug administration schedules, adverse reactions [side effects] and [drug-to-drug] interactions," the experts wrote.
Some efforts are underway to help ease the situation. In March of 2011, the Federal Advisory Council for the Elimination of Tuberculosis created a working group to address ongoing drug shortages, and in October 2011, a presidential order directed the U.S. Food and Drug Administration and the U.S. Department of Justice to fight drug shortages occurring across the health care spectrum.
"Reliable, consistent access to second-line drugs will require the collaboration of CDC, FDA, state and local health de
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