CHAMPAIGN — There are creams, ointments, liquids and lollypops being prepared in the compounding lab at Tony Jones' pharmacy.
They're all medicines customized to individual patients, and those patients generally live locally.
"If you get outside that realm, I think you begin to lose a little bit about what compounding is supposed to be," said Jones, owner of the Sullivan Pharmacy and Compounding Center, Sullivan. "It's supposed to be a relationship between a doctor, a patient and his pharmacy, with a valid prescription, focusing on a valid need."
That's a stark contrast to the Framingham, Mass., compounder tied to the deadly meningitis outbreak that was shipping drugs to 76 medical facilities in 23 states.
As of Friday, the fungal meningitis outbreak linked to an injectable steroid pain medication made by the New England Compounding Center has killed 32 people and sickened 438 more in 19 states.
The company was also shipping bulk orders of drugs without patient-specific prescriptions, in violation of state law, state officials said late last month.
Jones' pharmacy is one of at least four community pharmacies in East Central Illinois that do drug compounding in labs at their stores and serve a largely local area.
Others include Doug's Compounding Pharmacy in Paxton, Gibson City Pharmacy and St. Joseph Apothecary, St. Joseph.
Compounding pharmacists don't make brand new drugs. They use pharmaceutical base ingredients to customize drugs to fit individual needs, based on a prescription from a doctor or veterinarian.
Compounders mix forms of medications that can be easier for some patients to take, in strengths and doses that aren't commercially available, and that don't necessarily contain problem additives such as dyes and sugar, for such uses as pediatrics, wound care, pain management, hormone replacement therapy, veterinary care, dentistry and skin care.
The work can be extremely satisfying for a pharmacist.
"I've never gotten a thank you note for counting my 30 tablets correctly," said Kathy Munday, owner of St. Joseph Apothecary.
What she has gotten thanked for: Working with a doctor to mix a flavoring in a medication for a young child suffering from acid reflux so he could take it and get some sleep, and working with a veterinarian to compound a thyroid medication for a cat that got another five years of life.
Munday thought her customers might have some questions about compounding drug safety since the meningitis scare, but only a handful have asked her.
"I've been surprised," Munday said. "I thought we'd get a ton of calls."
Like the Sullivan pharmacy, the other three in the area largely focus on a single prescription at a time, owners or managers at all three say.
Maintaining that local doctor-patient-pharmacist "triad" relationship in his work is important to Doug Higgins, owner of Doug's Compounding Pharmacy.
His license would allow shipping larger quantities of products, he said, but he prefers being able to know what's going on with the patients receiving them.
"It would be kind of unnatural for me as a person where I don't have the ability to talk to the patient," he said.
All four local area compounders also distinguish themselves from NECC in another aspect: None of them does the sterile compounding required to produce the injectable drug that was involved in the outbreak.
Sterile compounding requires additional expense, testing and regulation and a highly controlled environment.
"Non-sterile, you don't have to worry about having what's called a clean room, a place where you make it with no bacteria, with no fungal, no mold, whatever, there's nothing in there that can grow, or should be. If you're doing it right there won't be," Higgins said.
His compounding area is clean enough, he said, but drugs compounded to be ingested into the stomach or spread on the skin don't need to be sterile.
"There are gazillions of bacteria that live in your digestive tract and on the skin," he added.
Higgins said he sends out two samples a week of what he compounds to test for potency and stability, but sterile compounding requires much more extensive testing.
Even adding a sterile facility would be expensive, Munday said; "that's why I've chosen not to do it."
The idea of compounding in big batches also isn't for her, she said.
"One patient at a time is what I've chosen to do," she said.