From: Daniel Pearson
To: Pharmacists
Sent: Thursday, October 12, 2017 3:45:25 PM
Subject: Meropenem Formulary Status Update
Attachment:
Alternative Antibiotic Regimens
Carbapenem Dosing Conversions 
Carbapenem Verification Process Visio

Good Afternoon,

This email is an update to the current meropenem formulary status. Starting October 16, meropenem, doripenem, and imipenem-cilastatin will be restricted to ID, Trauma, Pediatrics (Intensivists, Hospitalists, Oncologists), Pulmonary, and ED practitioners only.

Formulary Status / Verification Process

1. The automatic meropenem substitution will be discontinued.

2a. Starting October 16, meropenem, doripenem, and imipenem-cilastatin will be restricted to ID, Trauma, Pediatrics (Intensivists, Hospitalists, Oncologists), Pulmonary, and ED practitioners only.

2b. If imipenem-cilastatin or doripenem are written for by one of the approved groups, it is an automatic interchange to meropenem unless “NO SUB” is written (See Attached Carbapenem Dosing Conversion Table).

3a. If a non-approved physician orders meropenem, then you should check to see if ID is consulted. If ID is consulted then it is ok to verify the order.

3b. If a non-approved physican orders meropenem and ID is not consulted, then the pharmacist should call the ordering physician and discuss an alternative agent. The former automatic interchange table may be used as a reference when suggesting an alternative agent (See Attached Alternative Antibiotic Regimen Table). If the physician accepts your recommendation, then verify the new order.

3c. If a non-approved physician writes for meropenem without an ID consult and refuses your recommendation for an alternative agent, then you should verify meropenem for 24 hrs, move the order to “Pharmacy Follow-Up” in HCS and document who you spoke with, send an email to Jonathan Edwards letting AMT know of the order, and inform the ordering physician that you have verified the meropenem for 24 hrs and that Medical Staff Leadership (i.e. the P&T Chairman: Dr. Humphrey, the Chief Medical Officer: Dr. Chappell, or the ID physician on the P&T Committee Dr. Siddiqui) will be contacted since they will need to approve the meropenem use.

3d. If a non-approved physician writes for meropenem without an ID consult and you are unable to get in contact with the ordering physician, you should contact the physician on-call and follow steps 3b or 3c.

4. Ertapenem remains formulary, unrestricted. 

Background

For those that are new to Huntsville Hospital, in 2015 there was a carbapenem shortage and meropenem, doripenem, and imipenem-cilastatin were restricted to ID physicians only as a result of this shortage. The Carbapenem Backorder Interchange Policy was created for situations when meropenem, imipenem-cilastatin, and doripenem were written for by a non-ID physician. This policy gave the pharmacist the ability to automatically substitute ertapenem if non-pseudomonal ESBL coverage was needed or to a non-carbapenem such as piperacillin/tazobactam if ESBL coverage was not needed (See Table 1).

After the shortage ended, it was recommended by the Anti-Infective Subcommittee to continue the automatic interchange protocol. For the past 2 years this has been the policy in place at Huntsville Hospital.

Recently, several non-ID physicians requested that meropenem no longer be formulary restricted. After discussion from the Anti-Infective Subcommittee and P & T Committee through the P&T process, these formulary changes for meropenem and other anti-pseudomonal carbapenems at Huntsville Hospital were created.

Please let me know if you have any questions or issues with this program.
______________________________________
Daniel Pearson, Pharm.D.
PGY-1 Pharmacy Resident