Availability and use of therapeutic interchange policies in managing antimicrobial shortages among South African public sector hospitals; findings and implications

Audrey K. Chigome, Moliehi Matlala, Brian Godman, Johanna C. Meyer

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Background: Therapeutic interchange policies in hospitals are useful in dealing with antimicrobial shortages and minimising resistance rates. The extent of antimicrobial shortages and availability of therapeutic interchange policies is unknown among public sector hospitals in South Africa. This study aimed to ascertain the extent and rationale for dealing with antimicrobial shortages and describe policies or guidelines and the role of pharmacists in the process. Methods: A quantitative and descriptive study was conducted with a target population of 403 public sector hospitals. Data were collected from hospital pharmacists using an electronic questionnaire via SurveyMonkeyTM. Results: The response rate was 33.5% and most (83.3%) hospitals had experienced shortages in the previous six months. Antimicrobials commonly reported as out of stock included cloxacillin (54.3%), benzathine benzylpenicillin (54.2%), and erythromycin (39.6%). Reasons for shortages included pharmaceutical companies with supply constraints (85.3%) and an inefficient supply system. Only 42.4% had therapeutic interchange policies, and 88.9% contacted the prescriber when there for substitution. Conclusions: Antimicrobial shortages are prevalent in South African public sector hospitals with the most affected being penicillins and cephalosporins. Therapeutic interchange policies are not available at most hospitals. Effective strategies are required to improve communication between pharmacists and prescribers to ensure that safe, appropriate, and therapeutically equivalent alternatives are available.
Original languageEnglish
Article number4
Number of pages14
Issue number1
Publication statusPublished - 20 Dec 2019


  • antimicrobial shortages
  • antimicrobial stewardship
  • therapeutic interchange
  • pharmacists
  • public sector hospitals
  • south Africa

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