Hundreds of common drugs in short supply

Pharmacists are spending hours a day trying to fill prescriptions for standard antibiotics.

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A nationwide shortage of some types of antibiotics, particularly suspension formulas for children, is having an impact on patients, GPs and pharmacists.

And the shortage, particularly of amoxicillin, cefalexin and metronidazole, is just the tip of the iceberg, with more than 350 general medicines currently in shortage or unavailable.

In addition. other hard-to-get-drugs causing headaches are metformin, a range of antipsychotics and the well-publicised shortage of semaglutide and dulaglutide, type 2 diabetes drugs that have become increasingly popular for weight loss.

Sydney pharmacist Nick Logan has revealed he is spending hours a day talking to patients and trying to source medications, particularly suspension antibiotics for children.

“I think doctors are prescribing less and less antibiotics now … but at the moment there is no amoxicillin [suspension], there’s a little bit of cephalexin,” he says.

“Some days you’ve got some, and some days we ring around to find someone who’s managed to get hold of a bottle, it’s just completely unpredictable.

“We’re an average pharmacy and I would say we spend three hours a day phoning other pharmacies and phoning prescribers to try and change to a different molecule or rearrange the dose.”

The TGA’s website provides updated information on medicine shortages, which includes a searchable database for specific medications.

According to the database, at 18 January there were 378 current and 85 anticipated shortages.

TGA reporting shows 44 of the current and eight of the anticipated shortages are listed as critical, which means the shortage has the potential to have a life-threatening or serious impact on patients because suitable substitute medicines may not be readily available, or the medicine is listed on the Medicines Watch List.

“Whilst many of the shortages are expected to resolve in the next few months, we are aware of ongoing global constraints for some products which will see their shortages extend until the end of 2023,” the TGA says.

The current shortage, at 450 (per month), is lower than the monthly average since mandatory reporting of medicine shortages started in January 2019, and far less than the peak of 742 total notifications in April 2020.

“However, there are currently some very high-profile shortages, including of several antibiotics and diabetes medicines. These are worldwide shortages and are not limited to Australia,” the TGA says.

There are current shortages of 18 different antibiotic active ingredients, with 39 brands of antibiotics currently unavailable.

In response to the antibiotic shortage, the TGA has implemented a range of actions, including the publication of a dedicated antibiotic shortage webpage with advice for prescribers. This includes guidance on alternative brands or strengths of an antibiotic that is in shortage, if available.

The TGA has also approved multiple overseas-registered antibiotics for temporary supply under section 19A of the Therapeutic Goods Act 1989, some of which are listed on the PBS.

They have also made a serious scarcity substitution instrument (SSSI) for oral amoxicillin and oral cephalexin medicines.

This allows pharmacists to dispense another amoxicillin or cephalexin product to a patient when one is unavailable, without prior approval from the prescriber, so long as the conditions of the SSSI have been met.

Some prescription medication shortages are expected to ease when the government implements mandatory warehousing rules for suppliers this year.

From 1 July, as part of the PBS Medicines Supply Security Guarantee, minimum stockholding requirements will apply requiring manufacturers to hold a minimum of either four or six months’ stock in Australia for certain PBS-listed medicines.

The TGA has blamed most of the shortages on “manufacturing issues or an unexpected increase in demand”, but Mr Logan says there are other factors at play.

“The other thing with Australia is that there’s so much product being made overseas and the international manufacturers will sell it to countries that are prepared to pay more for it,” he says.

“Australia is reasonably cheap compared to the international cost of medicines. So that that’s why we’re not the first cab off the rank.”

He supports the new warehousing regulations, provided they are properly regulated.

Associate Professor Michael Clements, rural chair of the RACGP, also supports the implementation of the warehousing regulation, but says the current shortage also highlights the need to look long-term at the problem and see what medicines can be locally manufactured.

He says it’s also another reason not to expand the pool of prescribers.

“We can’t be opening up scripts carte blanche to anybody to prescribe, and in particular, I’m talking about trimethoprim and the antibiotics that the pharmacists want access to,” Professor Clements says.

“The Queensland study showed that 97% of [women who walked into a pharmacy] and asked for a script because they thought they might have UTI were given an antibiotic.

“We know that it’s more like 50% of them or even less than that would have had a UTI. So we need to make sure that we aren’t giving any political drivers to actually exacerbate the shortage. We really do need to restrict use.”

Professor Clements says having strong lines of communication between prescribers and pharmacists is vital in times of medicine shortages, particularly antibiotics.

As a rural GP in Townsville, he employs a pharmacist in his practice, and says that has been a big help in making clinical decisions when certain medications are unavailable.

He says the government and Primary Health Networks need to work more closely to provide alerts and information to time-poor GPs.

“We don’t have time to check the TGA site,” he says.

“We do occasionally we get alerts from either the PHN or some central email system telling us about a shortage but normally it’s about two months too late.

“Normally we’ve already been told by the pharmacist they can’t get something and then a few weeks later, an email from the government saying oh, by the way, this is in short supply.”