Antibiotic shortages disproportionately affecting Indigenous patients

Shortages of antibiotics used to treat rheumatic heart disease, syphilis, pneumonia and chlamydia have left many Aboriginal and Torres Strait Islander health organisations concerned about how this is disproportionately affecting remote Indigenous communities.
 
Currently, there are limited supplies of bicillin and azithromycin, and earlier this year there was also a shortage of ciproxin.
 
Although some of these medications may have unregistered or other alternatives, it rules out treatment options in areas where these conditions are endemic across all ages – such as using a liquid medication for children too young to ingest tablets.
 
National Aboriginal Community Controlled Health Organisation (NACCHO) Medicines Policy and Programs Director Mike Stephens​​​​ said health providers have had to ‘get creative’ to manage the ongoing shortages.
 
‘It’s interesting to note that some medications which are in shortage are certainly disproportionately used for the Aboriginal and Torres Strait Islander sector than other Australians,’ he told newsGP.
 
‘Clinical outcomes and patients are manifestly impacted in a negative way.
 
‘Just managing shortages is complex, and it creates confusion and complications for health professionals, clients, the system, and policy makers more generally.’
 
Various tactics have been employed, Mr Stephens said, to meet demand.
 
‘For example, there may be an ACCHO [Aboriginal community controlled health organisation] that has quite a lot of residual stock who is able to share or transfer some of that stock to another site and mitigate that burden,’ he said.
 
‘Or they can develop a protocol with a hospital where stock is reserved for very specific cases.
 
‘Using a network and working within the stakeholders in the local area is very important.’
 
As to the causes of the crisis, Mr Stephens said outbreaks and cost constraints could be leading factors.
 
‘Outbreaks, if they occur in a large population group, can have a manifest impact on the entire global supply,’ he said.
 
According to the Therapeutic Goods Administration (TGA), shortages of benzathine benzylpenicillin tetrahydrate are due to a global increase in demand, with stocks of higher strength injections expected to improve by mid-2024, but lower strength shortages will last until next year.
 
‘Benzathine benzylpenicillin plays a significant role in rural and remote community healthcare, and we acknowledge the critical importance of this medicine to First Nations people,’ the TGA says, as it takes measures to remedy this shortage.
 
Meanwhile, azithromycin shortages are expected to last until at least December this year.
 
RACGP Aboriginal and Torres Strait Islander Health Chair Dr Karen Nicholls described these shortages as ‘concerning’.
 
‘We know that the burden of some infectious diseases, such as acute rheumatic fever and the need for secondary prophylaxis, disproportionately effect Aboriginal and Torres Strait Islander peoples,’ she told newsGP.  
 
‘This is due to many complex issues and includes the social determinants of health such as overcrowding or inappropriate housing. 
 
‘Shortages of medications that can prevent the development of rheumatic heart disease is concerning.’ 
 
Aboriginal and Torres Strait Islander people are diagnosed with chlamydia two times more frequently than non-Indigenous Australians, and for gonorrhoea and syphilis the rate is more than five times as high.
 
Last year there was a reported tripling of syphilis rates.
 
Mr Stephens said it was very difficult to know the full impact across the country ‘because there’s not really any national surveillance systems or networks that actually capture this data in a quantitative way’.
 
‘There have been periodic shortages for years but there’s a relatively strong consensus that the shortages are getting worse and not likely to improve in the medium term,’ he said.
 
‘We need an enhanced response to shortages, as shortages globally are going to be an issue, but each is unique, and they’re commonly complex in how they need to be managed.’
 
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Aboriginal and Torres Strait Islander antibiotics medication shortage NACCHO remote communities