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The supply of Antibiotics is vulnerable

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In Norway, we primarily use narrow-spectrum antibiotics for many bacterial infections. The limited market and few manufacturers make the supply vulnerable, leading to a current shortage of a widely used penicillin.

The use of narrow-spectrum antibiotics is an important part of the strategy to slow down the development of antibiotic resistance. Compared to other countries outside the Nordic region, resistance is a minor issue in Norway. Limited antibiotic use and the use of narrow-spectrum antibiotics in the treatment of various infections contribute to this. 

Closely monitoring the situation 

There is currently a shortage of a common type of narrow-spectrum antibiotic, phenoxymethylpenicillin (Apocillin). Supply problems have been reported until spring 2024 for both strengths, 660 mg and 1 g, sold in Norway. Phenoxymethylpenicillin is used to treat respiratory infections such as throat infections and ear infections.

"Even though a shortage does not necessarily mean that a medicinal product is completely unavailable, this is a situation we are monitoring closely. Antibiotics are important medications, which is why we have Apocillin in our emergency stockpile. In addition, pharmacies can provide foreign packages of the same medication or switch to an equivalent medicines from another manufacturer. We hope that not many people will need to return to the doctor for a new prescription" says Senior Medical Consultant Ingrid Aas.

What Is the Cause of Shortages?

Medicine production is a global endeavor with a complex supply chain. Failure in one link can lead to delivery delays and shortages. Medicine shortages are an international problem and are often due to various production problems, raw material shortages, or higher sales than anticipated. International factors, such as war, conflict, energy crises, and high inflation, can also affect the supply of medicines.

When it comes to older medications like antibiotics, small countries with low sales volume are particularly vulnerable. They are less attractive to pharmaceutical companies. Additionally, there are few manufacturers of narrow-spectrum antibiotics, making the supply vulnerable. But other European countries have also experienced shortages of antibiotics. Many countries have faced a shortage of amoxicillin, which is a broader-spectrum type of antibiotic.

What happens if the Pharmacy doesn't have the packaging I have a prescription for?

In that case, you will either receive a foreign package of the same medicine or a medicine with the same active ingredient but from a different manufacturer. The packaging may look different from what you are used to, but the active ingredient is the same.

If your prescription is for the highest strength (1 g), it may be appropriate to use packaging with lower strength, taking more tablets. However, you will need a new prescription from your doctor to ensure the correct dosage.

If the pharmacy cannot provide you with alternatives, they should check if other pharmacies (including pharmacies in other chains) have the medication in stock. You can also check the stock status on the pharmacies' websites.

What does the Norwegian Medical Products Agency do?

Pharmaceutical companies that have medicinal products in the Norwegian market are obligated to supply them and should report supply problems so that we can make necessary preparations. We collaborate with manufacturers, pharmacies, and wholesalers, including granting permissions for the sale of foreign packaging. We also provide information and advice to doctors, patients, and pharmacies.

We actively work to encourage more manufacturers to market the medications we need in Norway. Additionally, we have recently increased the price of a group of older antibiotics that, due to their low price and low sales volume, may risk disappearing from the Norwegian market.

In 2022, European Medicines Agency (EMA) were given greater responsibility for crisis preparedness and crisis management. Shortages of antibiotics are closely monitored. We actively participate in the European regulatory network (on medicines) to prevent and reduce medicine shortages in Europe.

Why Are Foreign Packages More Expensive?

The price of foreign packages is not regulated by the authorities as the price of Norwegian packages is. It is the pharmacy chains themselves that set the price. They must source the packages from new suppliers, which can make it more expensive for you as a patient.

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Ingrid Aas

Unit: Better use of medicines

40021107

Ingrid.Aas@noma.no

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