Q&A for pharmacy professionals: What you need to know about the antibiotic shortages

In addition to the shortage of children’s acetaminophen and ibuprofen, Canada continues to experience supply shortages of some antibiotics. As of March 2023, there are positive indicators that demand has levelled off and the supply situation will continue to improve.

As the impact of these shortages are felt at the pharmacy level, we’ve put together this brief Q&A to help keep you updated on the situation.

Why is there a shortage of amoxicillin and other antibiotics?
Why would a surge in virus activity be leading to a shortage of antibiotics?
What antibiotics are impacted?
Is this a nation-wide shortage?
What is the federal government doing to address the shortage?
Is the federal government importing drugs to help address the shortage?
When will the situation be resolved?
What is CPhA doing to support pharmacists?
As a pharmacist, how can I help during this shortage?
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Why is there a shortage of amoxicillin and other antibiotics?

Starting in October 2022, a number of shortages impacting antibiotics, primarily amoxicillin, were reported through the national drug shortage reporting database (drugshortagescanada.ca) and supply shortages started to be felt in our communities across the country.

Similar to the acetaminophen/ibuprofen shortage, the shortage is the result of overwhelming demand driven by a surge in respiratory infections we saw in our communities this cold and flu season, particularly among children. While manufacturers reported that demand increased around 300-400%, as of March 2023 there are encouraging signs that the ability to meet demand will continue to improve.

Why would a surge in virus activity be leading to a shortage of antibiotics?

While we know that antibiotics, like amoxicillin, do not treat respiratory viruses such as RSV or the flu, it is frequently prescribed for bacterial infection like pneumonia. Often respiratory viral symptoms are similar to bacterial infections, or a virus can lead to secondary bacterial infections.

What antibiotics are impacted?

The shortage is primarily impacting amoxicillin. However, as pressure has grown on oral suspension and other forms of amoxicillin and prescribers have turned to alternative antibiotics, we have seen further impact on second line antibiotic therapies.

Is this a nation-wide shortage?

While the situation might have some regional variation, the supply issues are present across the country. Other countries, like the US and Australia are reporting shortages of amoxicillin, citing a significant increase in demand as well. This is considered a global shortage.

What is the federal government doing to address the shortage?

Health Canada is working with a broad range of stakeholders to better understand and address the situation, including manufacturers, distributors, health-care groups and others. On November 17, 2022, the shortage (Amoxicillin – Oral Suspension and Amoxicillin and Clavulanic Acid – Oral Suspension) was listed as a Tier 3 shortage, which are those that have the greatest potential impact on Canada's drug supply and health care system. CPhA sits on the Tier Assignment Committee (TAC) and was part of these recent discussions. Tier 3 classification allows for importation of foreign authorized drugs.

Is the federal government importing drugs to help address the shortage?

As part of its efforts to address the shortage with stakeholders, Health Canada has been exploring mitigation options which include the importation of foreign authorized drugs. In late December Health Canada approved the importation of foreign authorized amoxicillin.

When will the situation be resolved?

Supply has been increasing since late December 2022 and as of March 2023 demand has levelled off. Manufacturers and distributers report encouraging signs that the ability to meet demand will continue to improve.

What is CPhA doing to support pharmacists?

CPhA participates in regular drug shortage stakeholder meetings convened by Health Canada to better understand the situation, represent front-line pharmacists and keep you informed. We have conducted regular rapid surveys of pharmacy professionals across the country to better understand supply challenges and patient demand at the pharmacy level.

We have also developed a clinical resource to assist pharmacists/prescribers in determining alternative therapies and are collaborating with other health-care groups on additional resources. Our outreach also includes work with other prescribers/health-care groups to promote the important role of appropriate antibiotic prescribing/stewardship during the shortage.

In addition, we regularly participate in national media interviews about the shortage and emphasize the significant impact that drug shortages continue to have on our pharmacy teams.

As a pharmacist, how can I help during this shortage?

Firstly, we understand that these shortages are putting a lot of pressure on Canada’s pharmacy workforce, which is already under significant strain.

There are a number of ways pharmacy professionals can help during this shortage:

Helping patients: In addition to working with prescribers to find alternatives when required/applicable, educating and helping to calm the fears/anxiety of your patients can go a long way. See CPhA/medSask resource on amoxicillin alternatives for more info/support.
Helping the health-care system: Our hospitals are currently under significant strain and are struggling with capacity. Pharmacists are encouraged to use their expertise and professional judgement when exploring alternative therapies and coordinating care with prescribers and/or other health providers. Where possible, pharmacists should avoid referring patients to emergency departments to obtain or fill prescriptions.
Helping your pharmacy colleagues: Continue to purchase inventory based on usage. Avoid stockpiling inventory at the pharmacy to prevent artificial shortages in the drug distribution system.
Antibiotic stewardship: Pharmacists also have an important role to play in educating patients and other prescribers about the appropriate use of antibiotics. While generally stewardship activities are employed to address antibiotic resistance, the same principles of appropriate use apply during a shortage situation.