Shortage of antibiotics

The news media is full of reports of shortages of common antibiotics. Focus has been on penicillin-based antibiotics like amoxicillin, but the shortages have extended to other classes, including macrolides, such as erythromycin. The stories, at least in the United Kingdom, circle around the death of 16 children (total at the time of writing) from scarlet fever, a disease caused by invasive group A streptococcal infection (commonly known as strep A). There are obvious reasons for concern with children, but we should not forget the numbers are still tiny in respect to the population at large. For the most part, strep A manifests as a sore throat or relatively mild skin infection. In rare cases, the bacteria can get into the bloodstream, resulting in sepsis, a life-treating condition. On a personal level, the accompanying photograph is of my own ear with a streptococcal infection. It occurred when I was travelling around the United States and so I left it untreated – until I ended up in hospital on an antibiotic drip.

So what has led to the current shortage of antibiotics? The British government seem to deny there is a shortage, with the Prime Minister, Rishi Sunak, stating in Parliament, “there are no current shortages of drugs available to treat this [strep A] and there are well established procedures to ensure this remains the case”. This comes as a surprise to many pharmacists who are having significant problems getting antibiotics and moreover, the problem is world wide. In the United States, for example, the FDA announced there was “currently a shortage of antibiotic amoxicillin due to higher-than-usual demand to treat secondary infections caused by RSV, Covid-19, and the common cold which have surged this fall.”

The occurrence of strep A infection commonly rises during winter, but there appears to be an unusual increase in the number of strep A infections in the northern hemisphere this year. There is a widely circulating claim that lockdowns imposed because of Covid have weakened people’s immunity to bacterial infections, but the evidence for this is far from compelling. There is a possibility that reduced exposure has resulted in a lower immune response, but there are many other possible causes – the truth is we just do not know at present.

The increase in demand, plus what has been loosely termed, “supply chain issues” has resulted in the antibiotic shortage. These supply chain issues appear to revolve around covid restrictions in China, where many of the ingredients for antibiotic medicines originate, exacerbated by an explosion in the main Chinese production facility. The British Medical Journal* lists a number of factors besides those in China that have compounded to cause the current shortages. These include suspension of manufacture during the covid pandemic, increase in demand because drug use has been extended to other conditions and problems complying to Good Manufacturing Practices.

Reading the general press, you might believe the supply chain problems have just occurred and therefore caught us by surprise. But here’s the rub. The above mentioned British Medical Journal’s article was published in November last year and so governments and authorities were pre-warned. I have blogged previously on how warnings of a viral pandemic were ignored and how the conventional commercial model of antibiotic discovery has failed. It appears that once again lessons of the past go unheeded. I’ll end this blog post with the words of  Friedrich Hegel that echo to us from almost two hundred years ago,  “We learn from history that we do not learn from history”.

* Shafiq, N. Et al (2021) Shortage of essential antimicrobials: a major challenge to global health security. BMJ Global Health 2021;6:e006961. doi:10.1136/ bmjgh-2021-006961