old antibiotics

A recent article in The Lancet Infectious Diseases discusses the global shortage supply of old antibiotics and the necessity for prompt solutions to ensure patients have access to the most effective treatments.

While drug manufacturers are continuously developing new antibiotics, old antibiotics still treat the majority of common bacterial infections. These common infections are caused by pathogens that are still susceptible to old antibiotics. With a global shortage of old antibiotics, prescribers have limited treatment options and must lean towards newer, possibly less effective and more costly antibiotics. This global issue was reported by researchers at the Department of Medical Sciences of the Uppsala University in Sweden and published in the Lancet Infectious Diseases.

Data on the manufacturing and distribution of antibiotics is not publicly available. Physicians and pharmacists are usually unaware of this until they try to prescribe or dispense the drug and realize it is unavailable. Despite the lack of manufacturing information, reports on drug shortages and price increases are accessible.

Antibiotic drug shortages

A recent US report documented 148 antibiotic drug shortages between 2001 to 2013. In the Netherlands, a first-line intravenous antibiotic for pneumonia, benzylpenicillin, was out of stock in 2015. Piperacillin-tazobactam, a combination intravenous antibiotic indicated in the treatment of many severe infections in children and adults, was in very limited supply across the globe. This shortage was due to damage to one single factory in China. With all of these drug shortages, the price of old antibiotics has consequently skyrocketed.

There are many causes of the global shortage of old antibiotics. Over half of the antibiotic shortages in the US are due to manufacturing and quality concerns. As with the situation in China and the manufacturing of piperacillin-tazobactam, if only one producer exists, one failure can cause a global back order. Prescribers must also take into consideration the financial aspects of prescribing an older, more effective antibiotic that is in limited supply. The newer antibiotic option may not be the best first-line option but may be more desired due to lower cost.

International collaboration required

The urgency of the global antibiotic shortage is evident and prompt solutions are required. Not only should the national health authorities such as the FDA and Health Canada take responsibility for providing access to these old antibiotics, but international collaboration is also required. The authors predict that the situation will only worsen without leadership in addressing this global issue. A multidisciplinary group is required to map out the reasons for the shortages and increases in costs and to find effective solutions.

The implications of the global old antibiotics shortage are obvious. While newer antibiotics are more accessible they report having more side effects, being less effective, and contributing to antibiotic resistance. Urgent solutions to resolve the global shortage are necessary to provide patients with the best possible care.

Written by Jessica Caporuscio, PharmD

Reference: Tängdén T, Pulcini C, Aagaard H, et al. Unavailability of old antibiotics threatens effective treatment for common bacterial infections. Lancet Infect Dis. 2018

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