Piperacillin 4g / Tazobactam 500mg powder and solvent for solution for injection vials

Further to previous correspondence regarding pip/taz, DH/CMU continues to engage with all licenced suppliers to ascertain the overall supply position.

The current short term position is that supplies of product remain available however supply is anticipated to be severely constrained from April to the beginning of July.

Given the criticality of pip/taz, DH/CMU will continue to maintain regular dialogue with suppliers to confirm anticipated delivery dates and volumes and explore options to expedite any anticipated deliveries which are expected in the interim.

We would request that hospitals continue to order according to historic demand based on clinical need and DH/CMU will be working closely with supply chain stakeholders to ensure fair and equitable distribution of existing stocks.

In the event of hospital Trusts not being able to source pip/taz, DH/CMU have been engaging with antibiotic leads through UKMI and the DH Advisory Group on Antimicrobial Resistance and Healthcare Associated Infections who have now provided the following advice on appropriate alternatives:

Piperacillin/tazobactam is widely used in both the empiric treatment of suspected sepsis and targeted therapy in a range of clinical infection syndromes. It currently represents nearly a quarter of all parenteral (intravenous) antibiotic use in the NHS. Faced with a shortage in supply then as a first step all prescribers are encouraged to consider whether current use can be reduced to conserve local supplies. In practice this means emphasising the need for senior clinical review of all patients on piperacillin/tazobactam at 48-72 hours to determine if treatment can be changed to another effective antibiotic or stopped if there is no evidence of a clinical infection in line with the NHS Antibiotic Stewardship Guidance ‘Start Smart then Focus’ (https://www.gov.uk/government/publications/antimicrobial-stewardship-start-smart-then-focus).

A number of alternative antibiotics alone or in combination are widely used and effective in the empiric treatment of sepsis and community acquired infections. The 2016 Public Health England English Surveillance Programme on Antimicrobial Use and Resistance has reviewed coverage of E. coli blood stream infection for example and determined that sensitivity rates to combination therapy are around 95% for each of third generation cephalosporins with gentamicin, co-amoxiclav with gentamicin and ciprofloxacin with gentamicin combinations (https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report ). Targeted therapy will be based on the pathogen sensitivity and specialist infection advice as in usual clinical care.

A range of antibiotics are also available for empiric therapy for more seriously ill patients, including carbapenems. Local antimicrobial prescribing polices will need to be reviewed urgently by the relevant teams taking into consideration current antibiotic use and resistance profiles. Helpful data on local and regional antibiotic consumption and resistance to key pathogens is also available on the PHE Fingertips web page (https://fingertips.phe.org.uk/profile/amr-local-indicators) and through PHE’s second generation surveillance system (https://sgss.phe.org.uk/Security/Login?ReturnUrl=%2f ). Further guidance will be made available soon at a national level on more detailed alternative options for specific clinical infections.

DH/CMU will continue to engage with manufacturers of the suggested alternatives .

Further updates will be provided as and when received.

Yours sincerely

Clint Botha, Principal Pharmacist, Commercial Medicines Unit (CMU)
Department of Health
T. 0118 9027852