“We are dragging the tail of Covid with the consequent difficulties in the procurement of raw materials, I am referring precisely to the active ingredients of medicines which come mostly from non-European countries such as China and India”. These are the problems that the president of Federfarma Puglia, Francesco Fullone, identifies as the triggering cause of the shortage of antibiotic drugs (and not only) which has been creating considerable inconvenience in recent weeks for the citizens of Bari struggling with the difficulty of finding some medicines prescribed for the treatment of bacteriological respiratory inflammations and other widespread pathologies.
The shortage of medicines is evident above all in the case of amoxillicin, an antibiotic that is scarce in the Bari pharmacies. The shortage of the drug, however, is not an exclusive criticality of the Apulian capital: as explained by President Fullone (owner of a pharmacy in the center of Bari), preparations of this type of antibiotic are lacking throughout Italy and also in the rest of the Europe. “The war in Ukraine has raised the cost of energy and raw materials – specifies the regional president of Federfarma – this has also affected the materials used to package the drug, such as glass for example (for some bottles of syrup or saline solutions) and aluminum (for classic blister packs). Chinese ports were blocked for a long time due to Covid, trade was affected by this situation and therefore there was a shortage of raw materials that we still discount today” .
A winter marked by respiratory diseases
“The problems associated with the lack of raw materials – explains Fullone – last winter were joined by a very high incidence of respiratory diseases: in addition to the circulation of Covid, the flu virus spread widely, but there were also many bacterial diseases (bronchitis, laryngitis, tracheitis and other pathologies). There was therefore a request for medicines which ended up being excessive compared to the possibilities of pharmacies. We are verifying the shortage of some types of medicines not only in Bari, but throughout the national territory and also at European level”.
The antibiotic Amoxicillin is hard to find
“There are particularly worrying situations such as amoxicillin – explains the pharmacist from Bari – It is a very ancient antibiotic, a penicillin, which is used above all in some streptococcal diseases, which have had a particular upsurge in the infant population this winter/spring and juvenile. Faced with these situations, the tools are simply those relating to a replacement of the drug. In general cases, he can try with the equivalent medicines available. However, amoxicillin compensates for a widespread shortage of the drug. It is not a phenomenon yet relevant, but I point out that where possible, pharmacies have organized themselves to make galenic preparations: they are medicinal products that are prepared directly in the pharmacy. This technique can be a possible barrier to the problem, but it is not particularly widespread because unfortunately the raw material is missing to make this antibiotic compound.The solution, on the other hand, proved to be very effective last autumn, when it solved the shortage of anti-inflammatories with ibuprofen and pediatric Nurofen (which is now back in pharmacies). Amoxicillin is a drug of choice for some pathologies such as streptococcal and scarlet fever infections which are currently underway with rather important outbreaks. This has led to an increase in demand which there has been no capacity to answer. I am worried because not being able to respond to the request of a parent who needs a drug for their child creates tension and complicates the possibility of a correct therapy. The concern is tangible because we pharmacists are on the ‘front line’ and experience this situation. I always invite everyone, patients and parents, first of all to address the situation with the doctor who prescribes the treatment to identify alternative solutions. From a scientific point of view we have the tools to deal with this situation, we live in a society with gaps, but advanced from this point of view. I would be more concerned, however, if this condition of deficiency became a constant and continuous element: this aspect worries pharmacists in perspective. If, on the other hand, this contingent situation is overcome and the measures to remedy the current condition are implemented, a more virtuous circle can be created with the contraction of the drug production chains”.
Possible solutions to curb the shortage of medicines
“To remedy the shortage of medicines, it will be necessary to follow various paths – declares President Fullone – A regulatory part, to control the situation, is managed by Aifa (Italian Medicines Agency): the institutional body periodically publishes the list of lacking medicines , there is a long list of 3300 drugs. In reality that list must be lightened because the active ingredients actually lacking are much less. Monitoring the situation through the coordination of Aifa, it will be up to doctors and pharmacists to find within the same category of medicines a substitute for the possibly lacking medicine. There is a ministerial commission which is evaluating the problem. Covid has shown that the pharmaceutical industry supply chains must be shortened: it must be brought back within the European Union (and the Italy which is part of it) some segments of production. However, this is a topic that must be addressed at government level, also by the European Commission, so it will not be immediately received”.
Unnecessary stocks of medicines: harmful to citizens and the community
“Citizens must be careful not to fall into the trap of the so-called ‘bounce request’ – explains Francesco Fullone – the concern of not finding the drug leads the population to procure it improperly, before there is a need. Stock up , buying in a preventive way the lacking medicines, is a practice that must be avoided because it takes away the preparations from those who perhaps at that moment would really need them.This behavior had already occurred last autumn with the rush to buy inflammatory drugs with ibuprofen, it can therefore create a further aggravation of the problem related to the shortage of antibiotic drugs”.