Antimicrobial Stewardship Critical For Mitigating Antibiotic Shortages
In a systematic review of antibiotic drug shortages, researchers explored what causes them, how they impact health systems, and what officials commonly do to mitigate them.
The mitigation strategies used to combat antibiotic drug shortages rely significantly on the members of an antimicrobial stewardship (AMS) team, according to data published in Clinical Microbiology and Infection.1
“The lack of access to safe and effective antibiotics is a threat to global health security and contributes to the emergence and spread of antimicrobial resistance (AMR),” wrote authors of the study. “Increasingly common, shortages of antibiotics are an additional threat, hindering effective antimicrobial stewardship programs."
The clinical use of antibiotics dates back to the early 1900s when salvarsan was first developed by Paul Ehrlich to treat syphilis. Their use peaked in the mid-1900s with penicillin’s development subsequently extending humans’ global lifespan by up to 23 years, according to data published in Current Opinion in Microbiology.2 Since then, however, antibiotic developments have declined and led to the AMR crisis researchers of the current study explored.
The study was conducted to better understand the causes and consequences of antibiotic drug shortages. | image credit: Vii / stock.adobe.com
“Early in the COVID-19 pandemic, azithromycin was suggested as a potential therapeutic option; however, evidence soon emerged indicating its lack of efficacy for COVID-19,” they wrote.1 “Despite this, hoarding and inappropriate use led to its shortage in many countries.”
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With shortages of unprecedented levels persisting after the COVID-19 pandemic, researchers wanted to better understand the causes and consequences of antibiotic drug shortages. They first detailed patterns and causes of these shortages, then explored their impacts on health systems, patient outcomes, and supply chains. Finally, they laid out strategies for both managing and predicting drug shortages.
After searching through articles from 2000 to 2022, researchers included a total of 74 articles in the final analysis. Starting January 1, 2000, the time period of the study was crucial because it was “when supply chains and procurement systems began to change, with an increased reliance on single-supplier models, and the migration of active pharmaceutical ingredient (API) manufacturers to China and India.”1
Starting with the causes of antibiotic drug shortages, researchers noted that low supply of raw materials and APIs was the most common reasoning that led to a shortage. “The reliance on single-source manufacturers for APIs was a recurring theme, as was the lack of financial incentive to produce low-cost antibiotics,” they continued. “This was linked to supply and demand misalignment.”
The impacts of these shortages were even more detrimental to patients and antibiotic users around the world. Patients and providers were often forced to explore alternative, broad-spectrum therapies to treat infections. This, in turn, created greater demand for alternative agents and caused them to experience further drug shortages.
“In surveys evaluating the impact of antibiotic shortages, a significant shift in antibiotic use was observed, with a notable increase in the use of broad-spectrum antibiotics,” they wrote.1 “Previous surveys in 1999 and 2000 highlighted the impact of shortages on treatment regimens, with varying degrees of influence reported. Dispensing second, third, and fourth generation antibiotics and employing broader spectrum agents were common practices during shortages.”
Finally, the researchers explored evidence regarding the most successful mitigation strategies to help alleviate an antibiotic drug shortage. While immediate responses recommend the use of alternative agents and optimizing resources at the hospital level, sustainable long-term strategies should focus on the AMS team.
“The presence of AMS programs was associated with a positive response to managing shortages, as these programs actively track drug stocks, audit antibiotic use, and modify protocols to replace scarce antibiotics with alternatives,” wrote the authors.1 “AMS programs also impose preauthorization from infectious diseases specialists to ensure judicious antibiotic use during shortages and increase consultations and formulary restrictions.”
According to authors of a Clinical Infectious Diseases study,3 antibiotic drug shortages rank second among all pharmaceutical classes, with signs showing that these shortages will persist and increase in 2025 and beyond. While AMS teams are often placed at the center of antibiotic drug shortages, they are impacted most by them and are called upon to address them. But as the work of AMS teams continues, more research on the overall impacts of antibiotic shortages is necessary.
“The economic analysis of antibiotic shortages and their impact on healthcare systems remains underexplored. Robust and contextualized economic analyses would enhance understanding of the broader economic implications and support the development of policies aimed at minimizing these impacts,” concluded the authors.1
READ MORE: Health System Resource Center
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