Some 277 medicines in France are now in short supply this winter, including the antibiotic amoxicillin and the painkiller paracetamol as the spread of seasonal infections picks up pace.
Drug safety agency the Agence nationale de sécurité du médicament (ANSM) has confirmed that amoxicillin is now in short supply and “subject to significant strain in terms of availability in France [especially drinkable forms], which may last until March 2023”.
This shortage is partly due to a slowdown in production caused by the Covid-19 pandemic, with capacity still yet to reach pre-pandemic levels in some cases, but also due to a rise in antibiotic prescriptions, the agency said.
Drinkable forms of amoxicillin are often prescribed to children and infants.
General demand for the drug has increased by 51% in the past year. This is due to winter infections returning with a vengeance, after a significant drop over the past two years as a result of social distancing. A lack of immunity and closer social contact have led to a spike in cases.
Restrictions on boxes sold
In response, the ANSM has limited the number of boxes of amoxicillin that each pharmacy can order, and has also called on patients to only use this medicine if necessary. For example, it said that amoxicillin has no effect on bronchiolitis, which is currently at epidemic proportions in France.
The shortage of paracetamol has already led the agency to limit the sale of boxes to two per patient, per pharmacy. This is despite producers assuring them that they will not run out of the drug.
However, lobby group the Observatoire de la transparence dans les politiques du médicament has said that these measures “do not address the structural causes” of the shortages, and criticised authorities for their “lack of reaction” in the face of a “predictable” situation.
The ANSM has also asked manufacturers to boost their production capacity and said that “investigations are underway to identify importing routes from abroad”.
Wider medicine shortages
The two medicines have been added to the ANSM’s official list of important medicines suffering from major shortages. The list’s full name is the list of ‘médicaments d’intérêt thérapeutique majeur (MITM)’ or medicines of major clinical interest.
These MITM are, the agency says, “medicines for which an interruption of treatment could put patients’ health at risk in the short or medium term, or could represent a loss of an important opportunity for patients when it comes to the gravity or potential evolution of the illness”.
The shortage of medicines is not a recent problem but it has been getting worse this year. Inflation and geopolitical tensions due to the war in Ukraine have not helped.
However, even in 2019, the French lobbying group in the industry, Leem, said: “Since 2008, lack of stock and supply tensions have been increasing in a worrying way in France, but also in the US and other countries worldwide.”
During the height of the pandemic in 2020, a record 2,446 medicines were reported as at risk to the ANSM. A year later, the agency received 2,160 reports. This is five times’ higher than the number of reports received in, for example, 2016.
However, the ANSM has said that since 2019, it has requested that manufacturers signal the risk of shortages as early as possible to help it better anticipate any potential issues caused as a result.
It said: “This ‘anticipation policy’ means that we are seeing a rise in reports as a consequence.”
The main areas of shortage are medicines for the cardiovascular system (26.7% of reports), and the nervous system (25.55%). Anti-infection medication makes up 11.90% of reports.