For the past few weeks, pharmacists have been struggling to fill their cupboards. Between rising demand and disrupted deliveries, some antibiotics are now missing. To the point of pushing the health authorities to take action. The public medicine agency (ANSM) thus evoked the “strong supply tensions” on amoxicillin, an antibiotic widely used to treat children.
The shortage could last until March, leaving parents fearing a difficult winter. But why is this drug out of stock? How will we be able to take care of the children? 20 minutes takes stock with Pierre-Olivier Variot, president of the Union of community pharmacists.
What is amoxicillin?
Its name may not mean anything to you, yet it is the most widespread antibiotic. “It is a historic antibiotic, derived from penicillin, which is used as first-line treatment to treat many things”, explains Pierre-Olivier Variot. It is administered in particular against “ear infections, toothaches” or certain pneumonias. “Combined with clavulanic acid, it is also used more specifically for more resistant infections,” explains the pharmacist. But amoxicillin is mainly given alone to children, “especially in syrup”, against most bacterial infections.
Why is there a risk of a shortage of this drug?
It is precisely on syrup that French pharmacies are “already in supply tension”, points out the pharmacist. Several causes combine. “First, there is tension on the production of the molecule because demand is exploding” on a global level, explains Pierre-Olivier Variot. After several years marked by the Covid, the spread of other diseases had been slowed down, and stocks did not always follow. Then, the sector is indirectly affected by the war in Ukraine and the soaring prices of energy and certain raw materials. “The glass bottle used for the syrup is also under great tension”, specifies the president of the Union of Syndicates of Pharmacy Pharmacies, as well as the aluminum, making “the sachets more difficult to manufacture”.
But that’s not all. “The supply tension is global, but it is more marked in France”, according to him. In question, the price of the drug. “The production line is complex to set up because everything has to be cleaned, we don’t want to end up with another molecule in the bottle,” he explains. However, after years of intense production of vaccines for example, “transforming a production line to sell amoxicillin in France is not profitable”. “We pay for having the cheapest drugs in Europe: in France, the box of amoxicillin is sold for two or three euros, compared to twelve or thirteen in Great Britain, for the same production cost”, notes Pierre-Olivier Variot.
Will we be able to take care of our children this winter?
As in any shortage, “we must rationalize the use of this antibiotic”, believes Pierre-Olivier Variot, while we “exempt a lot and not always wisely”. The pharmacist is thus counting on doctors to “educate the population”: “if we only do the Covid test and give an antibiotic “just in case”, the patient will not take risks and choose the drug”, he presses. In the absence of amoxicillin, “we can transfer the patient to other less used antibiotics, but which will therefore also be in tension”, he warns.
It is therefore crucial to make more precise diagnoses. “There are tests which make it possible to check three viruses: Covid, influenza and RSV”, at the origin of bronchiolitis, of which France is undergoing an epidemic. Another type of test, “in the Netherlands there is a CRP assay, the level of which varies depending on whether the infection is viral or bacterial, and this for all types of infections”, enthuses Pierre-Olivier Variot. When the test shows the presence of a virus, the drug is useless. “If we managed to have these tests covered by Health Insurance, we would reduce the consumption of antibiotics” without altering the care provided, he says. In the Netherlands, the use of amoxicillin has thus fallen by 45% with the new tests. This would allow French pharmacies to have sufficient stock all winter for the children who will need it.