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You can find the current article at its original source at https://www.theguardian.com/society/2018/may/31/antibiotic-resistance-crisis-worsening-because-of-collapse-in-supply
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| Antibiotic resistance crisis worsening because of collapse in supply | Antibiotic resistance crisis worsening because of collapse in supply |
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| The antibiotic resistance crisis which is threatening to render many diseases untreatable is being fuelled not just by overuse of the drugs, but a fragile supply chain that is at risk of collapse, experts have warned. | The antibiotic resistance crisis which is threatening to render many diseases untreatable is being fuelled not just by overuse of the drugs, but a fragile supply chain that is at risk of collapse, experts have warned. |
| The authors of a white paper by the Dutch non-profit organisation Access to Medicine say a lack of access to specific antibiotics can lead to less appropriate drugs being prescribed for an infection, or even the use of lower doses – both of which increase the risk of antibiotic resistance – as well as delay for treatment. What’s more, they say, low stocks can lead to price hikes and mean poor quality medicines become rife. | The authors of a white paper by the Dutch non-profit organisation Access to Medicine say a lack of access to specific antibiotics can lead to less appropriate drugs being prescribed for an infection, or even the use of lower doses – both of which increase the risk of antibiotic resistance – as well as delay for treatment. What’s more, they say, low stocks can lead to price hikes and mean poor quality medicines become rife. |
| “The right products need to reach the right patients at the right time,” said Dr Jayasree Iyer, executive director of the Access to Medicine Foundation and co-author of the report. | “The right products need to reach the right patients at the right time,” said Dr Jayasree Iyer, executive director of the Access to Medicine Foundation and co-author of the report. |
| Antibiotic supply is patchy, complex and at risk of collapsing | Antibiotic supply is patchy, complex and at risk of collapsing |
| Among the shortages flagged is that of the common antibiotic benzathine penicillin G, which was found by to be unavailable in 39 countries in 2015, including India, Australia and the US, and is the only drug that can prevent and treat the transmission of syphilis from mother to child. The shortage, the report notes, coincided with the growing rise of syphilis in Brazil that has resulted in an uptick in babies born with congenital illnesses. | Among the shortages flagged is that of the common antibiotic benzathine penicillin G, which was found by to be unavailable in 39 countries in 2015, including India, Australia and the US, and is the only drug that can prevent and treat the transmission of syphilis from mother to child. The shortage, the report notes, coincided with the growing rise of syphilis in Brazil that has resulted in an uptick in babies born with congenital illnesses. |
| The report also cites a recent shortage of the intravenous antibiotic and antibacterial combination piperacillin-tazobactam. Caused by an explosion at a Chinese factory that produced raw materials for the medication, the situation led doctors in the UK to warn that patients were being put at risk from reliance on alternative medications, with supplies of the drug restricted to severe cases of sepsis and ventilator-acquired pneumonia. | The report also cites a recent shortage of the intravenous antibiotic and antibacterial combination piperacillin-tazobactam. Caused by an explosion at a Chinese factory that produced raw materials for the medication, the situation led doctors in the UK to warn that patients were being put at risk from reliance on alternative medications, with supplies of the drug restricted to severe cases of sepsis and ventilator-acquired pneumonia. |
| At present, more than 100 drugs, including a number of antibiotics, are listed by the US Food and Drug administration as being in short supply. | At present, more than 100 drugs, including a number of antibiotics, are listed by the US Food and Drug administration as being in short supply. |
| “Antibiotic supply is patchy, complex and at risk of collapsing,” the authors warn. | “Antibiotic supply is patchy, complex and at risk of collapsing,” the authors warn. |
| Iyer and colleagues say global shortages are down to a number of factors including low profits meaning low production levels and that it is expensive and risky to develop new antibiotics, with new products rarely widely used for fear of resistance developing. Indeed, companies have started to leave the market completely. | Iyer and colleagues say global shortages are down to a number of factors including low profits meaning low production levels and that it is expensive and risky to develop new antibiotics, with new products rarely widely used for fear of resistance developing. Indeed, companies have started to leave the market completely. |
| Antibiotic shortage puts patients at risk, doctors fear | |
| “Where on-patent antibiotics collectively generate $4.7bn in global sales annually, a single cancer medicine can generate twice that revenue in one year,” the authors write, adding that government actions to drive prices down add to the issue. Where demand for certain antibiotics is high, the team add, this often comes from poorer countries. | “Where on-patent antibiotics collectively generate $4.7bn in global sales annually, a single cancer medicine can generate twice that revenue in one year,” the authors write, adding that government actions to drive prices down add to the issue. Where demand for certain antibiotics is high, the team add, this often comes from poorer countries. |
| The team say there is also a lack of communication about stock and systems for redistributing stock, while production of ingredients for antibiotic medicines are largely confined to India and China, and sometimes produced by just one factory, meaning problems at the plant cause worldwide shortages. | The team say there is also a lack of communication about stock and systems for redistributing stock, while production of ingredients for antibiotic medicines are largely confined to India and China, and sometimes produced by just one factory, meaning problems at the plant cause worldwide shortages. |
| “We are making ourselves susceptible to problems when we are relying on so few [manufacturers] and we are not fixing the market,” said Iyer. | “We are making ourselves susceptible to problems when we are relying on so few [manufacturers] and we are not fixing the market,” said Iyer. |
| Iyer says the new report is a call to arms, and that pharmaceutical companies, governments and medical providers must come together to improve access to antibiotics. | Iyer says the new report is a call to arms, and that pharmaceutical companies, governments and medical providers must come together to improve access to antibiotics. |
| “The issue of access to antibiotics needs to be brought to a certain political agenda so that the multiple stakeholders are addressing this issue seriously,” she said. | “The issue of access to antibiotics needs to be brought to a certain political agenda so that the multiple stakeholders are addressing this issue seriously,” she said. |
| Iyer says global procurement systems for antibiotics must be created, and that governments must pitch in by offering companies incentives to develop new drugs, as well as producing older antibiotics, and making it easier to register antibiotics so they can be sold. | Iyer says global procurement systems for antibiotics must be created, and that governments must pitch in by offering companies incentives to develop new drugs, as well as producing older antibiotics, and making it easier to register antibiotics so they can be sold. |
| Dr Michael Blank, a doctor, described the report as sobering reading. “It leaves me with a chill that, despite having a diagnosis, I might have poor quality antibiotics; or worse still the wrong antibiotic that doesn’t work and may drive resistance, all because of an inadequate supply chain,” he said. | Dr Michael Blank, a doctor, described the report as sobering reading. “It leaves me with a chill that, despite having a diagnosis, I might have poor quality antibiotics; or worse still the wrong antibiotic that doesn’t work and may drive resistance, all because of an inadequate supply chain,” he said. |
| Philip Howard, a consultant antimicrobial pharmacist and spokesman for Royal Pharmaceutical Society agreed. “The ongoing shortages of current antibiotics are probably as large a problem as the lack of new antibiotics in development,” he said. “Until there is better transparency in the whole supply chain, then predicting global and local shortages will continue to be unpredictable. Whilst lessons can be learned from managing the HIV, TB and malaria treatments supply chain, it cannot be under-estimated how problematic a global solution will be due to the wide range and volume of antibiotics used.” | Philip Howard, a consultant antimicrobial pharmacist and spokesman for Royal Pharmaceutical Society agreed. “The ongoing shortages of current antibiotics are probably as large a problem as the lack of new antibiotics in development,” he said. “Until there is better transparency in the whole supply chain, then predicting global and local shortages will continue to be unpredictable. Whilst lessons can be learned from managing the HIV, TB and malaria treatments supply chain, it cannot be under-estimated how problematic a global solution will be due to the wide range and volume of antibiotics used.” |
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