Short supply of anti-fungal tablets causes worry

According to the Karnataka Drugs and Pharmacists’ Association, there has been no supply of the drug for the last 3 months

Published - July 19, 2018 12:52 am IST

Leela Kalayanaraman, who recently underwent a renal transplant here, is very anxious as a vital anti-fungal co-trimoxazole (brand name Septran) used as prophylaxis in transplant patients, is in short supply.

After her transplant, she was advised to take this tablet regularly, to stay safe from bacterial infections.

“As I had undergone a liver transplant too some years ago, I have to be extra careful and stay safe from all infections. We have been trying hard to get the tablet and have looked for it in several medical stores in the city. As of now, I have tablets that will last only for 15 days, and I’m not sure where I can get it from after that,” she told The Hindu .

This is not an isolated problem, but one faced by many across the country who are struggling to get the prophylactic drug.

The low-cost tablet (one strip costs ₹5.60) is a combination of sulfamethoxazole and trimethoprim which are commonly used to treat infections related to the urinary tract, middle ear (otitis media), bronchitis and other lung infections.

Patients are visiting one drugstore after another for the medicine. According to the Karnataka Drugs and Pharmacists’ Association, there has been no supply of the tablet for the last three months.

Difficult to find

Sankaran Sundar, chairman, Indian Society of Nephrology, Southern Chapter, said most of his patients have been affected because it has been difficult to find not just the branded drug of the sulfamethoxazole and trimethoprim combination (Septran and Septra) but also the generic kind.

“This medicine is also used to prevent or treat Pneumocystis carinii pneumonia (PCP), a very serious kind of pneumonia. This type of pneumonia occurs more commonly in patients whose immune systems are compromised, such as cancer patients, transplant patients, and patients with acquired immune deficiency syndrome (AIDS),” he said.

The Indian Society of Nephrology will soon write to the State Drug Controllers and National Pharmaceutical Pricing Authority (NPPA) in this regard.

“We are afraid this medicine will soon go out of stock and become an orphan drug. We want the authorities to address this issue at the earliest,” Dr Sundar said.

Paediatric suspension

Sudarshan Ballal, chairman, Manipal Hospitals, said owing to the shortage of co-trimoxazole tablets, doctors are prescribing paediatric suspension.

“But this is an expensive option as patients will have to use at least two bottles a day. It is a vital medicine and we are trying to bring this to the notice of NPPA,” Dr. Ballal said.

The issue has been gathering steam on social media and doctors from across the country have been tweeting about the shortage. “Doctors in All India Institute of Medical Sciences (AIIMS) and other top institutions have also raised concerns,” said Dr. Ballal.

Other drugs too

K.K. Aggarwal, president, Heart Care Foundation of India (HCFI), said it is not just co-trimoxazole (Septran) that is in short supply.

“Several drugs that have been brought under the National List of Essential Medicines (NLEM) are in short supply. This is because manufacturers do not find it viable to produce low cost drugs. For instance, Ditide, used for hypertension, and Penicillin LA Injection Penidure used in the treatment of bacterial infections, syphilis and prevention of rheumatic fever are also in short supply. My patients are finding it hard to procure these drugs,” he said.

‘Stocks available in Delhi’

Denying there is a shortage, Ritu Dhillon, Member Secretary, NPPA, told The Hindu that no grievance about drug shortage had been brought to their notice.

“According to the manufacturers, there are adequate stocks of the tablet in Delhi. State Drug Controllers can coordinate and get the stocks. However, if there is a further problem and brought to our notice we will initiate measures to ensure there is regular supply. There may be a gap in the supply chain,” she said.

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