GPs asked to limit antibiotic scripts due to ‘unprecedented’ shortage

NSW Health has requested that GPs limit prescriptions of two antibiotics amid a national shortage and rising rates of pneumonia, whooping cough and respiratory viruses in the state.
 
The request, sent out to GPs on 18 June, states that antibiotic oral liquids, including azithromycin and clarithromycin, may be in short supply due to increased demand.
 
‘Carefully consider the need for antibiotic treatment and if prescribing an antibiotic, consider current availability by consulting your local pharmacy,’ it reads.
 
The shortage, which is nationwide, is particularly acute in NSW due to the current rise in pneumoniae and pertussis infections.
 
Hurstville GP Dr Mariam Chaalan told Nine Newspapers she drove for four hours to find a pharmacy stocked with azithromycin for her sick son.
 
‘I knew he just wouldn’t be able to do a two-a-day dose antibiotic regime for seven days,’ she said.
 
Dr James Best, Chair of RACGP Specific Interests Child and Young Person’s Health, told newsGP generally GPs are ‘on the money’ when prescribing but there may a lack of awareness in the limited role of antibiotics for mild-to-moderate cases.
 
‘I think that was useful for us,’ he said.
 
‘Because we do really need to be hanging on to the antibiotics for the more severe cases.’
 
However, Dr Best has spoken out against an apparent move from Pfizer to limit its remaining stock of azithromycin oral liquid to hospitals only, saying it is ‘not appropriate’ and should only happen when it is ‘absolutely necessary from a supplier point of view.’

‘In general practice, we are seeking keep a child out of hospital,’ he said.
 
RACGP NSW&ACT Chair Dr Rebekah Hoffman told newsGP the shortage is leaving GPs with ‘a lot more legwork’.
 
‘This increases our workload significantly,’ she said.
 
‘It means that we have to call our pharmacists and ask what have you got in stock? What don’t you have in stock? What am I able to prescribe for my patients?
 
‘Sometimes that means calling one pharmacist or calling two or three or four pharmacists until we’re able to find one.’
 
But there is more urgency, Dr Hoffman says, when vulnerable people are unable to access the right medication.
 
‘For many patients they do need a course of antibiotics, especially when we’re talking about pregnant women and newborns,’ she said.
 
‘If they’re not able to access appropriate antibiotics we’re going to see it spread to more people at higher risk.’
 
In its letter to GPs, NSW Health ran through several treatment options, stating that ‘antibiotics have limited efficacy in most mild-moderate cases of confirmed or suspected Mycoplasma pneumoniae infection’.
 
It also notes that an international alternative, azithromycin (Zydus) 200 mg/5 mL powder for oral suspension, remains available.
 
To help manage the shortage, Dr Hoffman has been incorporating more testing into her practice, using swab tests to provide certainty about the infection.
 
‘When our patients come to see us, we are doing a swab test, like the same as we do with COVID, and adding that into our consults,’ she said.
 
‘They’ve got really fast turnaround times for those tests at the moment and usually they’re back within 24 hours.
 
‘If they’ve got RSV or another virus, we can reassure them that they don’t need antibiotics and that they will get better without them.’
 
With the shortage not limited to just azithromycin and clarithromycin, Dr Best says he is growing increasingly concerned about other antibiotics, such as Bicillin L-A, being unavailable in Australia.
 
‘These antibodies can be lifesaving at times, it can stop progression to severe disease,’ he said.
 
‘It’s a very large concern. If we don’t have the tools that we normally have available that can be very, very dangerous.’
 
A NSW Health spokesperson told newsGP the supply disruption is being addressed at a ‘national level’ by the Therapeutic Goods Administration.
 
‘Suppliers are working to expedite future shipments, with normal supply expected to resume over the coming months,’ they said.
 
Dr Hoffman is hopeful normal services returns even sooner.
 
‘It gets really tricky when we have antibiotic shortages,’ she said.
 
‘Often they’re unprecedented antibiotic shortages, we don’t know about them and we can’t expect them.’
 
Log in below to join the conversation.

antibiotic shortage antibiotics azithromycin clarithromycin general practice medication shortage pharmacy prescriptions