“Difficulties in the supply of amoxicillin, alone or in combination with clavulanic acid persist“, warns the Directorate General of Health in a communicated intended for health professionals and published on December 12, recalling that the prescription and the use of these antibiotics wisely is essential. To limit excessive shortages, she recommends that doctors prescribe amoxicillin individually rather than in a box. Thus, in practice, pharmacists will be able to dispense the exact number of tablets needed by the patient: the units remaining in the boxes will be kept at the pharmacy and can be used for subsequent prescriptions.
For their part, the infectious pathology group of the French Society of Pediatrics, the French Association of Ambulatory Pediatrics and the French Society of Infectious Pathology have recommended shortening treatment times for all frequent pathologies, in order to avoid a shortage of all oral forms of pediatric antibiotics.
On November 18, the ANSM also warned of “high supply tensions” on the oral forms of amoxicillin which could continue until March 2023. Shortages that also affect Gaviscon, fosfomycin against urinary infections where the Doliprane, which pushes pharmacists to find alternatives to replace it.
Any upcoming restrictions?
Limitation of the number of boxes ordered by pharmacies, prescriptions reduced to five days so as not to waste products and possibility of giving tablets to dissolve in water… Before the prescription per unit, the ANSM had already taken a whole series of measures. “We will especially remember the rules of good use “, recalled Alban Dhanani, deputy director of antibiotic drugs at the ANSM. Notably “in the event of a viral infection, there is no point in prescribing” antibiotics, he recalls. Measures that doctors’ organizations consider insufficient, which ask them to consider a “drastic restriction”. They also call for the diagnosis to be indicated on the prescriptions, in order to justify the prescription.
“We have challenged manufacturers in the sector to increase production chains that work seven days a week and 24 hours a day”, added the Minister of Health in November. Regarding amoxicillin, “we remobilized the entire sector, we prohibited the resale” To “other countries“.”The challenge, which is major, is that these are not drugs that are produced in France“, said François Braun, recalling that the government’s plan aims to bring back to France and Europe all the industries that ensure the production of essential drugs, “to ensure our sovereignty“.
But why is amoxicillin running out?
Amoxicillin is not only lacking in France, but also and especially in the United States and Canada. After a drop in consumption during the Covid-19 pandemic, production has been slowed down. In recent months, the demand for antibiotics has exploded again and laboratories are no longer able to keep up with demand.
But even worse, there are many drugs that are experiencing shortages. In 2021, 2,160 cases of stockouts were counted compared to 871 in 2018. The war in Ukraine also has a role in this shortage of medicine: the energy crisis initially slows down transport and “this country is one of the largest producers of aluminum, essential for blisters (packaging)”says Bruno Bonnemain, of the National Academy of Pharmacy.
Sources:
- Amoxicillin supply tensions: recommendations, DGS, December 12, 2022
- Press release Amoxicillin out of stock, November 18, 2022
- Amoxicillin: recommendations to help ensure coverage of patient needsANSM, November 18, 2022
- Out of stock of medicines: tensions over amoxicillin, the flagship antibiotic for children, The ParisianNovember 17, 2022
