Table 1.

Summarising some of the key antimicrobial shortages worldwide in the last 10 years and the causes and consequences of these shortages

Drug shortage	Timeline	Regions affected*	Cause	Consequences
Amoxicillin70	2018–2021	Canada, India	Suspension by manufacturer, disruption in supply of API due to pandemic, possible increase interest in investment in amoxicillin-clavulanic acid.	For community acquired infections, one may be compelled to use amoxicillin-clavulanic acid which is a broad-spectrum antimicrobial. The shortage of the paediatric formulation is particularly important.
Amphotericin B71	2021	India	Surge in demand as a first line treatment for mucormycosis.	Using alternative agents with no or sparse clinical trial evidence of efficacy, for example, posaconazole. Potential for treatment failure and increased morbidity and mortality.
Cefazolin3	2016 onwards	Japan, India	Decreased production, increased demand, price caps.	Cefazolin is a major drug recommended for surgical prophylaxis and for treatment of staphylococcal infections. Lack of its availability may compel use of alternatives which may not be as effective and could have broader spectrum, adversely affecting AMR.
Ceftolozane–tazobactam7	2021 onwards	European Union, Canada	Issues with compliance of good manufacturing practices.	Required for treatment of complicated intra-abdominal, urinary tract and other hospital acquired infections. May necessitate use of carbapenems.
Cloxacillin8 72	2017 onwards	USA, Europe, Canada, India	Disruption of manufacturing due to declining market returns.	Cloxacillin is an important drug for methicillin susceptible staphylococcal aureus infection, compels use of alternative agents such as amoxicillin-clavulanic acid or vancomycin leading to worse outcomes.
Cotrimoxazole73 74	2018 onwards	Africa, Australia	Suspension of production by manufacturing companies.	Cotrimoxazole is an important drug for community acquired infections and some hospital acquired infections. It is also an important drug for prophylaxis and treatment of opportunistic infections in immunocompromised states such as HIV infections.
Penicillin G75	2015– ongoing	39 countries	Only four companies produce the active pharmaceutical ingredient and due to lack of profitability production levels were kept low. Fragmented production process, including lack of regulation and quality standards in factories producing raw materials.	Restricts treatment options for syphilis and rheumatic heart disease—conditions disproportionately affecting low-income and middle-income countries. Increased risk of maternal to foetal transmission of syphilis. Increased costs of therapy as substitute therapies more expensive.
Piperacillin–tazobactam13	2017	Worldwide	Explosion at the sole factory in China supplying the active pharmaceutical ingredient.	Use of more broad-spectrum agents such as carbapenems. Increased use of cephalosporins with increasing risk of c-difficile infection.
Dapsone5	2017	Korea	Shortage of raw material and rising costs.	Compromises the management of both leprosy and several other dermatological conditions for which dapsone is often used.
TB medication shortages76–78	2011	UK, South Africa, India	Manufacture and supply chain issues for various drugs including ethionamide, clofazimine, streptomycin, rifabutin, protionamide, capreomycin.	Interruptions to TB therapy regimens including for MDR-TB therapy. Using unlicensed, variable-strength and unlicensed suspensions for paediatric dosing.

*The mentioned countries/regions are highlighted because they have reported shortages

AMR, antimicrobial resistance; API, active pharmaceutical ingredients; MDR-TB, multidrug-resistant tuberculosis; TB, tuberculosis.