Volume 32 • Number 12 • December 2011
How drug shortages are affecting pediatrics
Delays in treatment, reliance on less familiar
medications, key drugs rationed
Focus On Subspecialties
Is acetaminophen the
best choice of analgesic
for children with asthma?
by Lori O’Keefe • Correspondent
An executive order signed by President Obama
directs the Food and Drug Administration (FDA) to
provide more oversight over drug shortages to alleviate
this escalating problem that compromises patient
safety and medical care.
The order signed in October instructs the FDA to
urge manufacturers to provide advance notice of
potential issues that could lead to drug shortages;
expedite review of manufacturing changes that could
prevent medicine shortages; and work with the
Department of Justice to investigate possible price
gouging and medication hoarding that may have
occurred as a result of drug shortages.
Currently, 232 drugs are in short supply. This is
more than the record-setting shortage of 211 drugs
last year. It also is more than triple the amount in
short supply in 2005, when the shortage began to
worsen again following a steady improvement the
previous five years, according to the University of
Utah Drug Information Service.
by Julie P. Katkin, M.D., FAAP,
and John McBride, M.D.
What’s driving the problem?
The FDA indicates that more than half of the
injectable shortages are due to issues in production
quality such as contamination, particulates or impu-rities discovered in medications. Other reasons given
by the FDA for drug shortages include manufacturer
delays or capacity issues, drug discontinuations, raw
material issues, increase in demand in one medication
due to shortage of another drug, loss of manufacturing
sites, industry consolidation, and component problems or shortages.
See Drug shortages, page 4
An association between asthma and acetaminophen use was first reported in a 2000 study from
England. Since then, more than 15 studies have
confirmed that both adults and children who take
acetaminophen are more likely to have a diagnosis
of asthma or exhibit asthma symptoms.
Still, epidemiologists have been reluctant to conclude that acetaminophen causes asthma and generally have not recommended changes in practice.
A few have recommended that asthmatics limit
acetaminophen use until the relationship between
this common analgesic/antipyretic and asthma is
clarified by a randomized clinical trial.
This article focuses on the possibility that acetaminophen might increase airway inflammation
See Acetaminophen, page 12
Focus On Subspecialties
Consider kidney stones in youths
with abdominal pain,
The incidence of pediatric renal stone disease is increasing dramatically, especially in teenagers.
Whether measured by the number of emergency department visits, inpatient admissions or new referrals to a
pediatric nephrology practice, there has been a three- to
five-fold increase in the number of pediatric patients experiencing kidney stones for the first time over the last 10-
15 years. Most of this increase has been observed in
adolescents, especially teenage girls.
A recent analysis of the Kids’ Inpatient Database of
hospitals serving children showed that 70% of the pediatric
stone patients were girls, which differs from adult patients
where males predominate over females. Stone disease
remained quite low in African-American children of all
ages over this time period.
The reasons for this increase in stones are unclear. One
suspected cause may be the rise in the incidence of obesity,
which is associated with an increased risk of stone disease.
Dietary changes also may be playing a role, with increased
intake of fast foods, salt and carbonated sugary beverages.