Currently, we are using approximately 20 bags/day and at this rate, we have estimated a 14-17 day supply. At this time, please follow the recommendations listed below. We would like to avoid restricting this medication while on shortage. However, a restriction to dedicate remaining supply may be necessary and released as early as mid-next week. The Pharmacy Team is looking at all purchasing options each day. We are buying allocations when they are available and avoiding loaning our current supply.

Please work with your team to facilitate the below options. Please also be aware that, at this time, there is no automatic medication switches or discontinuations. All actions need to be approved with team, except for automatic IV to PO conversions meeting criteria.
PLAN:
Share shortage news with your teams
Be extra diligent with IV to PO/per tube conversions (po metronidazole is available at this time) – Please make this a high priority!
Discontinue unnecessary IV metronidazole and/or duplicate anaerobic coverage
Consider alternative IV anaerobic coverage agents, if needed (examples below – some helpful suggestions)
Anaerobic coverage (non-CNS): IV clindamycin **Reminder: Clindamycin does not penetrate CNS like metronidazole
Hospital acquired infection needing anaerobic coverage (non-CNS): Piperacillin/tazobactam, cefepime + clindamycin
Non-Pseudomonas risk infection needing anaerobic coverage (non-CNS): Ampicillin/sulbactam, cefoxitin, ceftriaxone + clindamycin, fluoroquinolone + clindamycin
Clostridium difficile: PO vancomycin
Please try to reserve IV metronidazole to those with:
CNS abscess
Clostridium difficile treatment in patients with high risk/no gut absorption requiring IV
We would like to avoid using carbapenems, but they are alternatives if the shortage worsens
Contact the ID Pharmacist or ID Team with any questions on substitution or alternatives

Details known on shortage:
Reason for the shortage: Manufacturer delays
Estimated resupply dates: BBraun and Claris are unable to estimate a release date; Pfizer estimates some additional allocation mid-September (not guaranteed)