title: How gaps in regulation of compounding pharmacy set the stage for a multistate fungal meningitis outbreak.
abstract: OBJECTIVE
  To provide an overview of the regulation issues surrounding compounding pharmacy that allowed the United States fungal meningitis outbreak to occur and the changes in regulation that ensued.
  
  
  CONCLUSIONS
  In September 2012, a single case report sparked an investigation into a nationwide outbreak of fungal meningitis due to contaminated injectable drugs. The source of the contamination, New England Compounding Center (NECC), was in violation of several state and federal laws and had a history of such violations. The regulation of compounding pharmacies has historically been left to the states, while manufacturing fell under the jurisdiction of the Food and Drug Administration. However, as more compounders took part in large-scale interstate distribution of drugs, the current state-based regulatory system became less equipped to provide oversight. The lack of a clear definition of "compounding pharmacy" further obscures proper oversight and regulation. Congress and several states have taken steps to build safeguards against large-scale compounding by increasing inspections, adopting stricter licensing requirements, and enacting the Drug Quality and Security Act of 2013.
  
  
  CONCLUSIONS
  While the current compounding regulation changes are a necessary step forward, it remains to be seen how effective they will be in safeguarding the public.
authors: Besu F
authors: BF
authors: Teshome
authors: Kelly R
authors: KR
authors: Reveles
authors: Grace C
authors: GC
authors: Lee
authors: Laurajo
authors: L
authors: Ryan
authors: Christopher R
authors: CR
authors: Frei
mesh_terms: D004196:Disease Outbreaks / Q000517:prevention & control*; D004339:Drug Compounding / Q000009:adverse effects / Q000592:standards*; D004340:Drug Contamination / Q000517:prevention & control; D006801:Humans; D016921:Meningitis, Fungal / Q000209:etiology* / Q000517:prevention & control; D010593:Pharmaceutical Services / Q000592:standards*; D010594:Pharmacies / Q000592:standards*; D012307:Risk Factors; D014481:United States; D014486:United States Food and Drug Administration