Netherlands still struggling with shortage of antibiotics for children

Pharmacies and hospitals still face an acute shortage of essential antibiotics typically used for babies and children. The National Coordination Center for Medicines has asked doctors to prescribe these medicines as little as possible and limit patients to one package at a time, the Volkskrant reports.

The shortage concerns antibiotic suspensions - antibiotics in liquid form - like amoxicillin and clarithromycin. They are the first choice for pneumonia, among other things, and suitable for babies, young children, and patients dependent on tube feeding.

“These are often vulnerable patients,” Mark de Boer, professor of infectious diseases at the Leiden University Medical Center (LUMC) and chairman of the Antibiotic Policy Working Group Foundation, told the newspaper. “It is not without reason that a number of the medicines currently in short supply are the first choice in treatment guidelines. Alternative treatments are usually less effective due to antibiotic resistance and have more side effects. These antibiotics are essential for the functioning of healthcare in the Netherlands.”

Nicole Hunfeld, a hospital pharmacist at Erasmus MC and chair of the Acute Shortages of Medicines Committee, thinks the antibiotic shortages will be a problem for a while yet. “They are sliding panels,” she told the newspaper. “If you go from one drink to another, we also see shortages arise there. We are constantly thinking of how to deal with the next shortage.” Demand is increasing worldwide, and because antibiotics are cheap, few manufacturers are inclined to produce them.

The supply of antibiotics in the Netherlands has decreased sharply in recent years. In 2013, there were still seven amoxicillin/clavulanic acid drink suppliers. Now, there’s one. The antibiotics cotrimoxazole and minocycline are also supplied by one supplier. Manufacturers have withdrawn because there is hardly any money to be made with antibiotics, Jean Hermans of the Bogin trade association told the Volkskrant.

“In 2019, a manufacturer withdrew antibiotics from the market, which are now in such a shortage, because the total turnover was 10,000 euros. The manufacturer must then pay, among other thighs, 1,500 euros in registration costs, and there will be high fines if you are unable to deliver for whatever reason,” Hermans said. The price for 100 millimeters of amoxicillin is still 3.72 euros at most, thanks to the Medicines Prices Act. “The government has the means to improve the pricing of these types of products but has not done so for years.”

Outgoing Health Minister Pia Dijkstra recently “emphatically” appealed to manufacturers who could produce antibiotics in the Netherlands to step up and do so. “Permits, everything that is necessary, is treated as a priority,” she said.

A Ministry spokesperson also told the Volkskrant that wholesalers and pharmaceutical companies are currently obliged to maintain a minimum stock of eight weeks. “And we are investigating how the security of supply can be increased, such as stimulating production closer to home or building up (emergency) stocks.”