How did we reach an antibiotics shortage?
March 24, 2023
Over-prescribed or under-supplied?
As Australia grapples with a rising antibiotic shortage, general practitioners across the country are growing increasingly concerned about the ability to provide the best possible care to their patients. According to recent reports, some of the most commonly used antibiotics, such as Metronidazole, Ozempic, and Champix, are in short supply, which is making it difficult for primary health practitioners to treat a wide range of medical conditions effectively.
Many GPs are feeling particularly frustrated, as they have never faced shortages of this magnitude before. Some feel extremely disadvantaged in this crisis, and consider a change in medications against the gold standard approach for various conditions. With a rapidly changing landscape, GPs are left in the dark about which medication may be in short supply, often notified simply by patients when they are unable to fill their script. This creates a delicate cause for concern and demands upskilling GPs as to what can act as substitute medications in these times. It is important to note that while the Australian government has made some efforts to address the situation, it is still a significant public health issue that requires a long-term solution.
In response to the crisis, the Therapeutic Goods Administration (TGA) has temporarily approved the supply of several overseas-registered alternatives for certain antibiotics. The shortage of antibiotics in Australia is not a new issue; it has been ongoing since January 2019. While disruptions to the supply chain can occur for a variety of reasons, including raw material shortages, logistical delays, and changes to Australian specifications, the COVID-19 pandemic has exacerbated the situation.
It is essential to recognize that medicine shortages have a significant impact on patients and their wellbeing. As such, the TGA is committed to working collaboratively with various stakeholders to reduce the impact of shortages on patients. Medicine sponsors are required to report shortages of prescription medicines and a small number of over-the-counter medicines to the TGA that occur or are expected to occur at a national level. However, while the TGA is doing what it can to address the issue, a more comprehensive solution is needed to ensure that patients have access to the medicines they require.
Reducing the use of Ozempic where possible
One of these medicines is Ozempic, a medication used to treat type 2 diabetes mellitus, which has also gained public interest recently as an appetite suppressant which can be used to enhance weight-loss. Novo Nordisk, the manufacturer, has limited quantities of the medication available for distribution to community pharmacies across the country. While supply is expected to improve over the next few weeks, it will remain quite limited for some time. To help ensure a more even distribution of the limited stock, the Department of Health and Aged Care has asked wholesalers supplying pharmacies to apply purchasing limits on pharmacies. The wholesalers have also been asked to prioritise filling pharmacy orders in rural and remote areas during the first few weeks, as patients in these areas have fewer choices of pharmacy to fill their prescriptions.
The TGA’s response
Following the uncertainty for health care providers around the country, the TGA have released a series of recommendations including:
– Health professionals are recommended to allocate the limited supplies of Ozempic to patients using the medication for registered indications, particularly those who have not been switched by their doctor to other glucose-lowering medicines.
– Patients who have been unable to obtain Ozempic and have switched to other medicines should speak to their doctor about their ongoing treatment. They may need to re-start on the introductory dose of Ozempic to minimise gastrointestinal side effects.
– Prescribers should avoid initiating new patients until supply stabilises and should continue to prioritise supply of Ozempic for people with type 2 diabetes who are current or previous users and for whom other medicines are not suitable. Patients may need to restart treatment with a prescription for semaglutide 0.25/0.5 mg 1.34 mg/mL pre-filled pen to minimise the risk of gastrointestinal side effects.
– Prescribers treating patients with obesity should continue to consider alternatives to semaglutide because supply will remain unstable for some time.
The TGA, health professionals, pharmaceutical wholesalers, patient groups, and Novo Nordisk are working together to manage the shortage and help patients as much as possible. Patients with a prescription for Ozempic should be mindful that there will likely be some difficulty in sourcing the medication, and they should only fill their script if their prescriber agrees that Ozempic continues to be the most appropriate medicine for them.
In conclusion, the shortage of antibiotics in Australia is a cause for concern. While there have been some efforts to mitigate the issue, it remains a significant public health challenge that requires a long-term solution. GPs must work with pharmacies to find substitutes for medications that are currently in short supply. However, given that medicines are not always easily substituted, it is critical to focus on finding a long-term solution that ensures that patients have access to the medications they need to maintain their health and wellbeing.