Table 1

Summarising some of the key antimicrobial shortages worldwide in the last 10 years and the causes and consequences of these shortages

Drug shortageTimelineRegions affected*CauseConsequences
Amoxicillin702018–2021Canada, IndiaSuspension by manufacturer, disruption in supply of API due to pandemic, possible increase interest in investment in amoxicillin-clavulanic acid.For community acquired infections, one may be compelled to use amoxicillin-clavulanic acid which is a broad-spectrum antimicrobial.
The shortage of the paediatric formulation is particularly important.
Amphotericin B712021IndiaSurge in demand as a first line treatment for mucormycosis.Using alternative agents with no or sparse clinical trial evidence of efficacy, for example, posaconazole.
Potential for treatment failure and increased morbidity and mortality.
Cefazolin32016 onwardsJapan, IndiaDecreased production, increased demand, price caps.Cefazolin is a major drug recommended for surgical prophylaxis and for treatment of staphylococcal infections. Lack of its availability may compel use of alternatives which may not be as effective and could have broader spectrum, adversely affecting AMR.
Ceftolozane–tazobactam72021 onwardsEuropean Union, CanadaIssues with compliance of good manufacturing practices.Required for treatment of complicated intra-abdominal, urinary tract and other hospital acquired infections. May necessitate use of carbapenems.
Cloxacillin8 722017 onwardsUSA, Europe, Canada, IndiaDisruption of manufacturing due to declining market returns.Cloxacillin is an important drug for methicillin susceptible staphylococcal aureus infection, compels use of alternative agents such as amoxicillin-clavulanic acid or vancomycin leading to worse outcomes.
Cotrimoxazole73 742018 onwardsAfrica, AustraliaSuspension of production by manufacturing companies.Cotrimoxazole is an important drug for community acquired infections and some hospital acquired infections. It is also an important drug for prophylaxis and treatment of opportunistic infections in immunocompromised states such as HIV infections.
Penicillin G752015– ongoing39 countriesOnly four companies produce the active pharmaceutical ingredient and due to lack of profitability production levels were kept low. Fragmented production process, including lack of regulation and quality standards in factories producing raw materials.Restricts treatment options for syphilis and rheumatic heart disease—conditions disproportionately affecting low-income and middle-income countries.
Increased risk of maternal to foetal transmission of syphilis.
Increased costs of therapy as substitute therapies more expensive.
Piperacillin–tazobactam132017WorldwideExplosion at the sole factory in China supplying the active pharmaceutical ingredient.Use of more broad-spectrum agents such as carbapenems. Increased use of cephalosporins with increasing risk of c-difficile infection.
Dapsone52017KoreaShortage of raw material and rising costs.Compromises the management of both leprosy and several other dermatological conditions for which dapsone is often used.
TB medication shortages76–782011UK, South Africa, IndiaManufacture and supply chain issues for various drugs including ethionamide, clofazimine, streptomycin, rifabutin, protionamide, capreomycin.Interruptions to TB therapy regimens including for MDR-TB therapy. Using unlicensed, variable-strength and unlicensed suspensions for paediatric dosing.
  • *The mentioned countries/regions are highlighted because they have reported shortages

  • AMR, antimicrobial resistance; API, active pharmaceutical ingredients; MDR-TB, multidrug-resistant tuberculosis; TB, tuberculosis.