title: Bacterial pneumonias during an influenza pandemic: how will we allocate antibiotics?
abstract: We are currently in the midst of the 2009 H1N1 pandemic, and a second wave of flu in the fall and winter could lead to more hospitalizations for pneumonia. Recent pathologic and historic data from the 1918 influenza pandemic confirms that many, if not most, of the deaths in that pandemic were a result of secondary bacterial pneumonias. This means that a second wave of 2009 H1N1 pandemic influenza could result in a widespread shortage of antibiotics, making these medications a scarce resource. Recently, our University of Michigan Health System (UMHS) Scarce Resource Allocation Committee (SRAC) added antibiotics to a list of resources (including ventilators, antivirals, vaccines) that might become scarce during an influenza pandemic. In this article, we summarize the data on bacterial pneumonias during the 1918 influenza pandemic, discuss the possible impact of a pandemic on the University of Michigan Health System, and summarize our committee's guiding principles for allocating antibiotics during a pandemic.
authors.affiliation: Infectious Diseases, University of Michigan Hospitals/VA Ann Arbor Health Systems, Ann Arbor, Michigan 48105, USA. scinti@umich.edu
authors.forename: Sandro K
authors.initials: SK
authors.lastname: Cinti
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Barnosky
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gay
authors.forename: Susan Dorr
authors.initials: SD
authors.lastname: Goold
authors.forename: Marie M
authors.initials: MM
authors.lastname: Lozon
authors.forename: Kristin
authors.initials: K
authors.lastname: Kim
authors.forename: Phillip E
authors.initials: PE
authors.lastname: Rodgers
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Baum
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cadwallender
authors.forename: Curtis D
authors.initials: CD
authors.lastname: Collins
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Wright
authors.forename: Robert A
authors.initials: RA
authors.lastname: Winfield
mesh_terms: D000900:Anti-Bacterial Agents / Q000600:supply & distribution*; D049673:History, 20th Century; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000188:drug therapy*; D007362:Intensive Care Units; D010045:Outpatients; D010166:Palliative Care; D010372:Pediatrics; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000209:etiology / Q000266:history; D040841:Resource Allocation / Q000941:ethics / Q000458:organization & administration*; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents