The recent meningitis outbreak involves a compounding pharmacy; in that case, it was a steroid for epidural administration. Most compounding pharmacies are small, and they are regular pharmacies who happen to do compounding. Most of the meds they make are oral meds, and to date there have been very few reports of adverse consequences from these compounding pharmacies, and they serve a good purpose.
HOWEVER, in the case of this meningitis outbreak, thngs are much different. Here, I believe that some of the pain clinics ordered the drug from the New Endgland compounder due to cost factors, which is not good. Most of the time when we order compounded drugs, they are not available commercially, as it is not for our financial gain; in fact, the patient deals directly with the pharmacy, we never take ahold of the medicine. In this case, the compounder sent the steroid vials to the pain clinics, who then administered them.
There are many questions to be answered about this incredible meningitis outbreak; these include: how did the Aspergillus get into the steroid solution to begin with….how did they detect/notice that cases of meningitis were linked to this batch from this pharmacy(good work, whoever figured that out), and how long did it take to figure it out(I think weeks)…….why did all these pain clinics order the vials(the 2 reasons are 1.money, and 2. these vials do not have preservative, which can be an advantage in a small # of sensitive patients)……..What to do with the patients, how long to treat them……etc etc.
This is unprecedented: usually, people who get fungal meningitis have a severely compromised immune system(from AIDS or cancer/chemotherapy). In this situation, 14,000 people who are relatively healthy had spinal injections of a steroid that contained Aspergillus, a fungus. This is an unprecedented event. It presents a nitemare from a treatment perspective, as the anti-fungal meds are powerful, and people(who survive) need to be on them for a long long time. Also, there will be fallout, in some unfortunate patients, from the meningitis, such as back pain/thinking problems/headaches/etc. This is a sad, tragic, evolving story, and we will have the answers in due time.
