Antibiotic widely used in adults as in children, amoxicillin has been a molecule in tension for several years. Are we heading towards a shortage? What are the risks of lack for this molecule? Will the situation get worse? Response elements.
These are for the moment only feedback from the field from pediatricians or pharmacists but the information is crucial: amoxicillin in the pediatric form could come to run out in the coming weeks.
For Dr. Andreas Werner, pediatrician and president of the AFPA, the shortage is expected for the next few weeks. “By the end of the year, a shortage of amoxicillin is expected. It will quickly become complicated to obtain it in pharmacies” he warns. Bad news for parents who will need this antibiotic to treat their child, with the arrival of winter and the first sore throats and other bacterial infections requiring an antibiotic.
No frank shortage, for the moment
However, nothing says for the moment that the pharmacies will experience a complete rupture of amoxicillin. According to Dr. Yves Dour, pharmacist in Le Mans and member of the Doctissimo expert committee, “no official information has been received for the moment, but it is true that some of the pediatric forms are missing, in turn”.
The National Medicines Safety Agency (ANSM) indicates for its part a return to normal of the molecule in pediatric format on the shelves of pharmacies, last September, after a beginning of rupture. “With the exception of certain laboratories which may present some tensions, these drugs are made available normally” can be read on its website.
When questioned, the agency nevertheless recognizes a difficult situation: “Amoxicillin is subject to strong supply tensions in France, which could last until March 2023. The forms most affected are the oral forms of amoxicillin Clamoxyl and Augmentin in particular (powder for oral suspension 125 mg/ 5ml, 250mg/5ml and 500mg/5ml). A quota is already in place with city pharmacies and in health establishments to better manage the available stocks.. Other oral forms, more intended for adults (tablets, capsules, etc.), are also the subject of tensions too, specifies the Agency.
Adapt medication
Supply difficulties are also reported by pharmacies near Niort, as reported by our colleagues from The New Republic. The pharmacists explain that they have difficulty obtaining the drugs from their usual suppliers, suspecting a rupture to come, without having further explanations on the situation. Some even explain having had to “improvise” by adapting a tablet intended for adults to the dosage of the child, by explaining to the parents how to dissolve it in a liquid.
A troubled chain
“The purpose for a laboratory is to provide the right drug to the patient who needs it.“says Thomas Borel, scientific director at LEEM, the organization representing drug companies in France.
According to him, several elements come into play in the manufacturing chain of a drug like amoxicillin. “The more difficult supply of raw materials, the production of sufficient quantities by players, while global demand continues to grow, the difficulties of access to the materials used for containers (aluminum, cardboard, etc.)”. So many elements that multiply the difficulties between the production of the drug and the consumer at the end of the chain, according to him.
The ANSM specifies for its part that “these amoxicillin shortages affect all of Europe, as well as other international markets” and “are the consequence of a very significant increase in the consumption of antibiotics coupled with difficulties on industrial production lines which have not regained their production capacity prior to the Covid-19 pandemic“.
Difficulties in other countries
In Canada also precisely, the federal agency Health Canada warns of a possible shortage of the molecule in the country. Is there competition between States for the supply of amoxicillin? “This is the case for certain molecules, when a price differential is quite significant” explains Thomas Borel. “We can then imagine, it is not excluded, that certain laboratories make their stocks available to the countries that will pay the most for them. Although this is not the main cause of the supply tensions for amoxicillin, it should be remembered that its selling price in France is lower than that of neighboring countries in Europe.“he assures.
Discuss alternatives
While waiting for an improvement of the situation, precautions of use are essential. Shortage or not, “you really have to avoid giving antibiotics automatically because it’s not very good for children” Dr. Werner rightly recalls.
Pediatricians and general practitioners will probably be even more vigilant to respect this rule when prescribing this winter. The ANSM also announces that it is working on the development of “recommendations for care adapted to this context of tensions” and also asks health professionals to “respect the therapeutic recommendations in force on the proper use of antibiotics”.
These recommendations are finally published on their site on November 18, 2022.
The ANSM therefore recalls that antibiotics are ineffective against viral infections, including bronchiolitis, influenza, Covid-19, nasopharyngitis and the vast majority of angina and otitis. She adds that:
- “If you have a viral infection, your doctor will not prescribe antibiotics. You can ask your doctor for a non-prescription order.
- Due to difficulties in the supply of amoxicillin, it is possible that the pharmacy will contact your doctor to define another effective antibiotic or another form of amoxicillin adapted to your situation;
- If an antibiotic has been prescribed to treat angina, your pharmacist will check that a test to detect bacterial angina has been carried out by your doctor. If not, he can contact your doctor to discuss it. If your child is over 10 years old, the pharmacist can carry out this test himself.
What if the molecule was really missing? Other antibiotics exist, it will then be necessary to discuss alternatives with your doctor.