An inquest this week heard how Kenneth Beazley (80), a ‘handsome and debonair’ man, was prescribed a bacteriostatic antibiotic fusidic acid in conjunction with statin medication, which proved fatal.
In December of last year Mr Beazley presented with a sore knee to his doctor of over 30 years, Dr Peter Morahan. After a consultation with orthopaedic surgeon Dr Richard Creedon, it was decided that Mr Beazley should take a fusidic acid antibiotic. He was admitted to hospital in January suffering from ‘decreasing mobility issues and muscle weakness’ and died a short time later from a cardiac arrest. Speaking at the inquest, Dr Morahan stated “he was not aware of any problems with prescribing fuisdic acid antibiotics to a patient on statins”. He said in his 35 years as a GP he had never heard of the potentially fatal interaction between the two drugs.
So who is to blame for Mr Beazley’s death? The fact is he died from the medical treatment he received – an iatrogenic death (Induced by a physician’s activity, manner, or therapy). Medical misadventure was found to be the cause of death. Despite the doctor being unaware of interactions, the Coroner Dr Myra Cullinane stated that she had previously issued a warning about the usage of statin medication in combination with fusidic acid. In 2008, a 58 year old man, John Devereux, presented to his GP with an infected toe. He died the following month from a ‘horrific muscle-eating condition’ due to being prescribed the same medication combination as Mr Beazley. The jury at Mr Devereux’s inquest returned a verdict of ‘death by misadventure’ and recommended that “the drug information about both Lipitor and Fusidic Acid be reviewed by the manufacturers involved” and further, that “doctors review the use of anti-cholesterol treatments with chronically ill patients who are taking other strong medications”. At that time the Irish Medicines Board (renamed HPRA) were reportedly ‘looking into’ Mr Devereux death and three other similar Irish cases. In 2013, Mr Deveraux’s wife Margaret took an action against the HSE for negligence and breach of their duty of care, for failure to recognise that the combination of Lipitor and fusidic acid could cause the onset of a muscle break down condition (rhabdmoloysis). The action was settled by the HSE for a measly €45,000.
So why then can doctors be unaware of the terrible consequences of prescribing both, an issue that has seemingly been publicised for decades?
Can doctors really be unaware that the EMA (European Medicine’s Agency) issued a warning in 2011 against prescribing Statins with a Fusidic acid antibiotic? Can they be unaware that the UK’s HPRA (Medicines and Healthcare Products Regulatory Agency) recommended when prescribing both, that “Patients should be closely monitored” and “temporary suspension of simvastatin treatment may be considered”? What about the HPRA warning that treatment with statins and fusidic acid are contraindicated? It’s expressly stated on the SPC (Summary of Product Characteristics for doctors).
In 2010, Dublin’s Beaumont hospital found that following the deaths of 3 patients taking fusidic acid and statins –” fatal complications may be relatively high“. So why are doctor’s seemingly so uneducated on the adverse effects of prescribing certain medications, particularly as Ireland’s increasing polypharmacy is becoming more and more acceptable?
Following Mr Devereux’s death in 2008, his consultant nephrologist Dr Michael Clarkson said although he was unaware at that time that atorvastatin reacted with fucidic acid, following a consultation with colleagues he found there had been three other fatal cases in Ireland. They reported all four Irish cases to the Irish Medicines Board and said “it was no longer the practice at Cork (University Hospital) to co-prescribe fucidic acid and statins to patients”.
There seems to be a lack of communication between the various regulators and the medical profession. Will the deceased patient be blamed once again for not reading the PIL (patient Information Leaflet), or will the doctor’s get a slap on the wrist from the Medical Council for not observing the following and consequently killing their patient? RIP to Mr Beazley, Mr Devereax and all victims of iatrogenesis.