Canadian Pharmacists Association
Canadian Pharmacists Association

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, there is a growing shortage of antibiotics, primarily impacting liquid formulations of amoxicillin. 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?

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

Similar to the acetaminophen/ibuprofen shortage, the shortage is the result of an overwhelming demand that is driven by a surge in respiratory infections we are seeing in our communities, particularly among children. Manufacturers are reporting that demand has been increasing since June and is generally up 300-400%.

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 and bronchitis. Often respiratory viral symptoms are similar to bacterial infections, or a virus can lead to secondary bacterial infections.

What antibiotics are impacted?

Presently, the shortage is primarily impacting amoxicillin. As pressure continues to grow on oral suspension and other forms of amoxicillin and prescribers turn to alternative antibiotics, we may start to see 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. The shortage (Amoxicillin – Oral Suspension and Amoxicillin and Clavulanic Acid – Oral Suspension) was recently 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. Given that this is a global shortage, efforts to import antibiotic products from outside Canada may be more challenging.

When will the situation be resolved?

While we’ve heard that some manufacturers are attempting to expedite upcoming shipments, generally it is expected that supply will start to stabilize in late December/January. While it’s difficult to predict future demand and how the rates of illness in our communities will contribute to it, we are hopeful that if the situation is appropriately managed the impact on patients can be mitigated.

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 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 pharmacists can help during this shortage:

  • 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.
  • 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.
  • 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.

Last updated: November 17, 2022