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Antibiotics shortages in Europe: what you need to know
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Antibiotics shortages in Europe: what you need to know

“A new approach is needed to better tackle medicines shortages in the European Health Union,” the European Commission said in an official communication regarding current antibiotics shortages.1 A 2018 analysis from the World Health Organisation estimates the cost of a shortage of just one antibiotic to be €20-30 million.2 Discover the key facts around antibiotic shortages and what is being done to address them this season. 

Why have we been experiencing antibiotics shortages?

Unfortunately, antibiotics shortages have become more common.3 

One global analysis from 2018 found that antibiotics shortages could be attributed to:3 

  • Lacking commercial incentive and market 
  • Weak forecasting systems 
  • Single-source or gaps in active pharmaceutical ingredients and other essential materials 
  • Limited quality manufacturing of source materials 
  • Complex and fragmented procurement of products 
  • Regulatory challenges 
  • Inadequate constitutive recognition of access to essential medicines 

A systematic review found that between 2019 and 2020, during the COVID-19 pandemic, antibiotic consumption rose in hospitals to treat bacterial coinfection.4 Some studies claimed interruptions or reductions in antibiotic stewardship programmes also played a role.4 The situation has continued to develop, with the winter of 2022-2023 bringing changing infection patterns resulting in an increased demand and in turn, a critical shortage of antibiotics.1  

Manufacturers found it challenging to respond quickly to the rising demand due to long lead times that would be needed to boost production.1 

Who is impacted by antibiotics shortages?

Though the impact of shortages is not well documented in literature, we know that there is a direct impact on healthcare outcomes.3 Antibiotics shortages threaten effective, timely therapy.3 To ensure timely care, many healthcare professionals may resort to alternative antibiotics, which could impact the effectiveness of treatment.3 

The use of suboptimal antibiotics could lead to drug-resistant infections and greater antimicrobial resistance.3 In fact, the US Centre for Disease Control estimates that unnecessary and suboptimal use of antibiotics could account for up to 50% of all outpatient antibiotic use, with 28% of prescriptions not needed at all.5 

In the European Union, antimicrobial resistance is responsible for an estimated 33,000 deaths per year.6 Global deaths related to antimicrobial resistance are estimated to reach 10 million by 2050.7 It is also expensive; in 2019, antimicrobial resistance and its ineffective treatment cost European Economic Area healthcare systems €1.1 billion.6 

More on this topic: Achieving infection prevention and control—The Portuguese Experience

How can we ensure sufficient supply of antibiotics?

The European Medicines Agency (EMA)’s Executive Steering Group on Shortages and Safety of Medicinal Products published three key ways that antibiotics shortages can be addressed in the region:8 

  • Increase production: Engage with marketing authorisation holders to prioritise measures that will increase production 
  • Monitor supply and demand: Order medicines as normal (no stockpiling) as the EMA, European Commission and Member States monitor supply and demand.  
  • Awareness and responsible use: Only prescribe antibiotics to treat bacterial infections to help avoid antimicrobial resistance (not effective against viral infections, such as cold and flu) 

The European Commission has proposed pharmaceutical legislation as well as measures to help improve the availability of key antibiotics, including an intensified information exchange with international companies and stakeholders to keep a close eye on the progress this winter season to detect and proactively address supply shortfalls.8 

Despite the calls to address shortages, the most recent data from the European Commission suggests that this season’s supply of key antibiotics in the European Union should generally match demand, if demand doesn’t significantly differ from previous years.8 

References

  1. European Commission. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions: Addressing medicine shortages in the EU. Brussels, 24 Oct 2023. 
  2. World Health Organisation. Meeting Report; Antibiotic Shortages: Magnitude, Causes and Possible Solutions. Oslo, 10-11 December 2019.  
  3. Shafiq N, Pandey AK, Malhotra S et al. Shortage of essential antimicrobials: a major challenge to global health security. BMJ Glob Health. 2021; 6(11): e006961. DOI: 10.1136/bmjgh-2021-006961. 
  4. Fukushige M, Ngo NH, Lukmanto D, Fukuda S, Ohneda O. Effect of the COVID-19 pandemic on antibiotic consumption: A systematic review comparing 2019 and 2020 data. Front Public Health. 2022; 10:946077. DOI: 10.3389/fpubh.2022.946077. 
  5. Centers for Disease Control and Prevention (CDC). Measuring Outpatient Antibiotic Prescribing. Published 5 October 2022. Accessed 23 November 2023 at: https://www.cdc.gov/antibiotic-use/data/outpatient-prescribing/index.html 
  6. OECD. Antimicrobial Resistance: Tackling the Burden in the European Union. Published 2019. Accessed 23 November 2023. 
  7. O’Neill J. Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. The Review on Antimicrobial Resistance. Published December 2014. Accessed 23 November 2023. 
  8. European Medicines Agency. European Health Union: EU steps up action to prevent shortages of antibiotics for next winter. Published 17 July 2023. Accessed 20 November 2023 at: https://www.ema.europa.eu/en/news/european-health-union-eu-steps-action-prevent-shortages-antibiotics-next-winter. 

This list of references to third-party peer-reviewed material and the sites they are hosted on are provided for your reference and convenience only, and do not imply any review or endorsement of the material or any association with their operators.  The Third-Party References (and the Web sites to which they link) may contain information that is inaccurate, incomplete, or outdated. Your access and use of the Third Party Sites (and any Web sites to which they link) is solely at your own risk.  

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