Unprecedented medication supply issues that began in the pandemic continue, with antibiotic shortages impacting well over half of GPs and their patients. Paediatric suspensions have been particularly affected.

In a recent Healthed survey of more than 1500 GPs, 59% of respondents reported difficulty accessing antibiotics in the past three months.

“There have been real delays and shortages with materials needed for both making and delivering antibiotics, whether the chemicals needed to make the drugs or the plastic containers that house them,” says University of Sydney Professor Robert Booy, an infectious diseases paediatrician.

The most common supply issues have been with amoxicillin (including in combination with clavulanic acid), cefalexin, phenoxymethylpenicillin and trimethoprim (including in combination with sulfamethoxazole).

Australian National University Associate Professor Sanjaya Senanyake, a Canberra-based infectious diseases physician, says the scale of the shortage stands out.

“It’s not uncommon over the years to have a shortage of one or two particular antibiotics, but what we’re seeing right now is quite a few at the same time,” Associate Professor Senanyake says.

In Healthed’s survey, 35% of GPs reported seeing at least one patient experience a negative health outcome due to antibiotic supply issues in the last three months—and 14% of that group said they’d seen five of more patients in that unfortunate situation.

Associate Professor Senanayake says that he has not yet seen any dire outcomes, but the shortages are indeed negatively impacting patient care by making it difficult to access the best medication in a timely manner.

“I saw one patient sent to me after a few weeks, and the organism was actually resistant to the antibiotic they’d been put on,” he says. “Something could have flared, but thankfully it didn’t. Throw in a few allergies and it becomes very difficult at a general practice level.”

Acting chief medical officer of the Australian Commission on Safety and Quality in Health Care Associate Professor Carolyn Hullick says the TGA is closely monitoring the situation and has approved multiple overseas-registered alternatives for temporary local supply.

Finding an alternative

“While this can be concerning for patients and doctors alike, it is possible to get the medications your patients need,” Associate Professor Hullick says.

Associate Professor Hullick says the TGA’s “Serious Scarcity Substitution Instruments” for oral amoxicillin, cephalexin and phenoxymethylpenicillin allow pharmacists to dispense alternative dosage forms or strengths of the prescribed antibiotic without prior approval from the prescriber. The TGA is also working with wholesalers to facilitate equitable distribution and prevent stockpiling.

The Therapeutic Guidelines have also released an updated summary of antibiotic choices for GPs. It includes aids for deciding whether to prescribe any antibiotic, which one to pick, and alternatives for when the first line is unavailable. This includes different formulations of the same medication (for example, some tablets can be crushed for paediatric use, while others can’t), different medications if appropriate, or alternative access pathways.

However, the guidelines make a point that first-line choices should remain first-line wherever possible. While the other options may be appropriate when absolutely necessary, they may be less efficacious, have a suboptimal spectrum of activity, or have a less favourable harm-benefit ratio.

The National Centre for Antimicrobial Stewardship also has updated fact sheets about alternative options during specific shortages.

Associate Professor Hullick says the Therapeutic Guidelines direct prescribing to
“antibiotics with the lowest potential for promoting the development of resistance, and to ensure that patients receive an appropriate antibiotic to treat their infection…Ultimately, we all want to ensure that our patients receive the best possible treatment.”

So is there an end in sight?

The TGA has been somewhat vague, saying in its latest update in June that despite progress, some antibiotic shortages could continue through the end of the year.

“We expect many of the shortages to resolve in the next few months, and many have already resolved. However, there are ongoing global constraints for some products which will see their shortages extend until the end of 2023.”