four questions on supply tensions surrounding this antibiotic

Certain versions of this medication have become rarer in pharmacies in recent months. The National Medicines Safety Agency announced Tuesday that deliveries are underway.

Amoxicillin has been in short supply since the fall in pharmacies. The most prescribed antibiotic in France is particularly difficult to find in pharmacies in its drinkable version. The National Medicines Safety Agency (ANSM), which recognizes “significant difficulties”asked, Tuesday, December 26, the industrialists of “immediately make available to wholesalers-distributors [les intermédiaires entre les fabricants et les officines] most of their stocks”. The ANSM also announced thatare deliveries are ” in progress” among these wholesalers-distributors, who “will ensure a fair distribution of these across the territory”. Franceinfo takes stock of the situation by answering four questions related to the shortage of this drug.

1 What is the stock status?

Since this fall, the medicines safety agency, but also patient associations and pharmacists themselves, have noted that amoxicillin is absent from certain pharmacies. The ANSM notes that as of Friday December 22, the situation was tense at the level of wholesalers, who are responsible for distributing orders to pharmacies. Except for the version oral 1000 mg, they had less than three days of inventory. The observation was similar for pharmacies regarding stocks of amoxicillin in drinkable form, prescribed in pediatrics.

On the other hand, stocks of this antibiotic are greater than one month among manufacturers, whatever the forms of the antibiotic, according to the ANSM inventory. “This situation is incomprehensible”denounces the president of the Federation of Pharmaceutical Unions of France, Philippe Besset. “We have been asking manufacturers for months, but we have no answer”.

2 What explains this situation?

Drug shortages have not been uncommon in recent years. However, that of winter 2022-2023 was particularly virulent, on the one hand due to a triple epidemic of flu, Covid-19 and bronchiolitis, on the other hand because of supply tensions on certain drugs.

This fall, pharmacists and patients said they feared experiencing the same situation again. However, unlike the previous year, the recent tensions can no longer be explained by a lack of molecules, but by a poor distribution of stocks. Aurélien Rousseau, then Minister of Health, pointed out at the beginning of October on France Inter the “overstocks” made by some “big pharmacies” to the detriment of small pharmacies.

At the end of December, the problem shifted somewhat, with manufacturers finding themselves singled out. “They have two to three months of stocks, compared to two to five days with pharmacists”deplores today Pierre-Olivier Variot, president of theUnion of community pharmacists’ unions (Uspo). This last denounces a lack of transparency, harming the entire drug distribution chain.

3 What measures have been taken?

Due to severe shortages of medicines at the end of 2022-beginning of 2023, a winter plan was launched by the medicines agency. It aims to “anticipate and limit tensions on certain major winter medications”such as amoxicillin or paracetamol, “and thus secure their availability in order to meet the needs of patients”.

Furthermore, at the request of the Ministry of Health, pharmaceutical groups, wholesalers and pharmacists committed in November, in a symbolic charter, to distributing the distribution of antibiotics in order to guarantee access to them for patients. However, no sanctions are provided for in the event of failure to fulfill this promise.

Nevertheless, the medicine policeman has a new means of coercion, ratified by the publication in the Official Journal on Wednesday of the law relating to the 2024 Social Security budget. The ANSM can now, “in the event of a shortage or risk of a disruption in the supply of a drug of major therapeutic interest”such as amoxicillin, “take the necessary health measures to guarantee an appropriate and continuous supply”.

From Tuesday, the ANSM asked manufacturers to “immediately make the majority of their stocks available to wholesalers-distributors”so that the boxes are “distributed fairly in pharmacies and positioned as close as possible to patients”. “I am very happy that the agency has seized its new power as quickly as possible”welcomes the president of the Federation of Pharmaceutical Unions of France, Philippe Besset.

4 When could the situation improve?

In the field, “the situation started to improve last week regarding tablets”, observes Pierre-Olivier Variot. For the pediatric version of the drug, deliveries arrive from “this week”. “Releasing stock means releasing trucks, which can take four to six days”specifies the president of Uspo.

While waiting for these drugs to become available again, the ANSM reminds that it “is always possible for pharmacists to directly deliver a compounded preparation suitable for children under 12 years old”. In other words, if the pharmacist does not have amoxicillin on hand, he can prepare dosages suitable for a particular patient, upon medical prescription.