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Whooping cough: DH reactivates two SSPs for antibiotic clarithromycin

The government has reactivated two serious shortage protocols (SSPs) for the antibiotic clarithromycin amid the ongoing outbreak of whooping cough, the pharmacy negotiator has announced.

Community Pharmacy England (CPE) said today (May 22) that “ministers have authorised the Department of Health and Social Care (DHS) to reactivate two SSPs” for clarithromycin 125mg/5ml and 250mg/5ml oral suspension.

It added that this was in response to a “significant ongoing disruption to the supply” of the antibiotic.

The news comes as the government warned in March that whooping cough cases were skyrocketing - with more than 500 cases in England this January compared with a total of almost 860 “for the whole of” last year.

Read more: Whooping coughing cases skyrocketing, warns government

According to the National Institute for Health and Care Excellence (NICE), “clarithromycin is preferred” for “infants under one month” who are suffering from whooping cough.

Both SSPs are effective as of today and provide for the following:

  • SSP053 – for every 5ml of Clarithromycin 125mg/5ml oral suspension, 2.5ml of Clarithromycin 250mg/5ml oral suspension must be supplied
  • SSP054 – for every 5ml of Clarithromycin 250mg/5ml oral suspension, one Clarithromycin 250mg tablet must be supplied

They are currently set to expire on June 21 2024, CPE said.

CPE stressed that SSP053 “does not allow the substitution of oral suspension for tablets” and that the protocols “do not allow for the quantity supplied to be less than the number of days prescribed on original prescription”.

The “supervising pharmacist should ensure that the patient’s prescriber is notified when supplying a patient in accordance with these SSPs”, it added.


No hoard list


This morning (May 22), the DH and the Medicines and Healthcare products Regulatory Agency (MHRA) added the antibiotic to the list of drugs that wholesalers are prevented from exporting or hoarding.

The DH uses the regularly updated ‘list of medicines that cannot be exported from the UK or hoarded’ when there is “evidence of a critical shortage, or a risk of critical shortage, which could adversely impact UK patients”, according to its website.

Read more: DH and MHRA ban wholesalers from hoarding or exporting five ADHD drugs

The 250mg/5ml strength of the drug was previously subject to an SSP between April 2023 and November 2023, while the 125mg/5ml strength was under an SSP between April 2023 to January 2024, according to the now-updated NHS Business Services Authority (NHBSA) website.


“Medicine supply disruptions can be localised”


CPE told C+D earlier this week (May 21) that it had “not received any shortage reports about clarithromycin from pharmacy owners recently” but added that the medicine “has been subject to price concessions of late and has been for some time, indicating longer lasting pricing issues”.

It said that “medicine supply disruptions can be localised in nature and fluctuate on a daily basis”. 

Read more: Revealed: London pharmacies will offer children’s MMR jabs following case surge

Independent Pharmacies Association (IPA) chief executive Dr Leyla Hannbeck told C+D that it is “astonishing” that the DH “denied supply issues at first” but has now issued the new SSPs.

“It shows that they are only reactive,” she said, adding that the sector needs a “national strategy on medicines supply challenges where DHSC involves all stakeholders including community pharmacies”.

“This situation cannot continue,” Hannbeck told C+D. 

Read more: Pharmacy First could ‘make it even easier’ to deliver MMR jabs, says minister

And Ellie Bennett, managing director of Wicker Pharmacy in Sheffield, said on Tuesday (May 21) that “there have been clarithromycin shortages with the suspension on and off since the SSP last year”.

She added that the pharmacy has “been unable to get the 125mg/5ml suspension at various points in the past few months” but that it was available at the time “above drug tariff”.

In December, a new NHS England (NHSE) vaccination strategy set out plans to give community pharmacy “a greater role in seasonal vaccination” in the future. 

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