How Antibiotic Shortages Increase Medication Errors in Healthcare

Recent reports underscore the widespread prevalence of antibiotic shortages, which precipitate significant disruptions in patient care. These shortages necessitate the use of alternative, less familiar medications by healthcare providers, consequently elevating the incidence of medication errors in healthcare settings. Continue reading to learn more about the impact of antibiotic shortages on patient safety and how to mitigate their effects.

Recent Reports on Antibiotic Shortages

According to the Food and Drug Administration’s (FDA) database on drug shortages, as of February 2024, there are currently 15 types of antibiotics in shortage. While this may seem relatively small compared to the over 100 antibiotics recognized by the FDA, these medications are critically essential.

Amoxicillin is currently on the list of antibiotics experiencing a shortage. This medication is frequently prescribed to children for common illnesses such as strep throat or ear infections and is the most prescribed antibiotic in the United States. Substitutions of this medication are often stronger, meaning they have a higher potential for killing off healthy bacteria, which can lead to gastronomical issues or fungal infections.

Another antibiotic currently in shortage is Penicillin G Benzathine, better known as Bicillin, the preferred injectable antibiotic treatment for syphilis. Between 2018 and 2022, syphilis rates rose by about 80%, causing a large demand for a medication that was already in short supply due to its difficulty in production.

Public health agencies recommend that providers prioritize pregnant patients for the medication during shortages, as it is the only syphilis treatment considered safe for them. This prioritization is crucial due to the risks of congenital syphilis, which can lead to birth defects, miscarriages, and stillbirths.

The current and persistent shortages of antibiotics underscore a larger issue. Unlike shortages of other medications, antibiotic shortages do not occur in isolation, and their ramifications can have far-reaching consequences through patient care.

Due to the complex nature of antibiotics, compounded by the growing population that is either allergic or resistant to certain antibiotics, antibiotic shortages have ripple effects through care delivery. These shortages not only force clinicians to ration or supplement antibiotic treatment but also increase the likelihood of medication errors in healthcare as providers navigate alternative treatment options amidst limited availability.

What Causes Antibiotic Shortages

Antibiotic shortages result from a combination of factors, ranging from challenges in production intricacies to broader systemic issues within the healthcare and pharmaceutical sectors. These factors include:

Manufacturing Issues: Antibiotic production is a meticulous process that requires stringent quality control measures and adherence to regulatory standards. Manufacturing disruptions, such as equipment failures, contamination issues, or supply chain disruptions, can lead to interruptions in production and subsequent shortages of critical antibiotics.

Regulatory Challenges: Regulatory requirements imposed by health authorities can impact the availability of antibiotics. Changes in regulatory standards, inspections, or compliance issues may temporarily halt production or distribution, leading to shortages in the market.

Global Health Emergencies: Public health crises, such as pandemics or widespread outbreaks of infectious diseases, can strain healthcare systems and increase demand for antibiotics. During such emergencies, there may be sudden surges in antibiotic usage, leading to shortages if supply cannot adequately meet demand.

Limited Investment in Research and Development: The pipeline for new antibiotic development has dwindled in recent years due to scientific challenges, high research and development costs, and limited financial incentives for pharmaceutical companies. Without a steady influx of new antibiotics to address emerging resistant strains, existing antibiotics may face increased demand, further exacerbating shortages.

Antibiotic Resistance: The emergence of antibiotic-resistant bacteria poses a significant challenge to antibiotic efficacy, exacerbating the situation by making diseases like salmonellosis and pneumonia harder to treat due to declining antibiotic effectiveness. As certain antibiotics become less potent against resistant strains, healthcare providers may need to rely on alternative antibiotics, further increasing demand and potentially leading to shortages of these alternatives.

The Impact of Antibiotic Shortages on Medication Errors in Healthcare

Drug shortages, particularly of antibiotics, cause stress, frustration, and burnout among healthcare providers, leading to poor morale and increased error risks. In fact, physicians whose surveys revealed signs of burnout were 2.2 times as likely to report a perceived medical error.

Clinicians often must resort to prescribing alternatives or adjusting dosages, which can confuse staff members unaccustomed to handling these medications.

Furthermore, shortages may result in unfamiliar doses or packaging, further complicating the medication process and increasing the likelihood of medication errors in healthcare at various stages, including prescribing, dispensing, and administering.

Medication errors in healthcare pose serious risks to patient safety, potentially leading to adverse reactions, treatment failure, prolonged hospital stays, and even death. The FDA receives more than 100,000 reports every year that are associated with medication errors. 

Antibiotic medication errors can result in negative patient outcomes such as:

• Prolonged Illness: Patients may suffer longer due to delays in treatment caused by antibiotic errors.
• Increased Risk of Complications: Inadequate antibiotic treatment raises risks of complications such as sepsis or secondary infections.
• Spread of Infections: Inadequately treated infections can lead to the spread of contagious diseases within communities or healthcare settings, posing risks to other individuals.
• Mortality: Severe cases may result in mortality due to untreated critical infections from improper antibiotic treatment.

How To Mitigate Effects of Antibiotic Shortages

Antibiotic shortages are common in healthcare, but there are steps organizations can take to prevent medication errors in healthcare and other risks to patient safety.

1. Follow Antibiotic Stewardship Guidelines: Antibiotic stewardship is a coordinated effort to optimize the use of antibiotics to improve patient outcomes while minimizing the emergence of antibiotic resistance and reducing unnecessary antibiotic use. This practice involves implementing strategies to ensure that antibiotics are prescribed appropriately, at the right dose, for the right duration, and for the right indication.
2. Prompt Communication: Clear communication and coordination among clinicians and staff are crucial for swiftly identifying shortages and implementing alternative treatment strategies. This includes relaying information on antibiotic availability and changes in prescribing protocols to all relevant staff, including pharmacists, supply chain managers, and other stakeholders, to ensure a comprehensive approach to managing shortages.
3. Monitor Medication Shortage Information: Organizations should regularly monitor the FDA's drug supply and shortage information. Staying informed about potential shortages allows organizations to better prepare and anticipate any disruptions in the availability of antibiotics.
4. Promote Incident Reporting: Promote incident reporting among staff to identify and address medication errors promptly, ensuring patient safety amid antibiotic shortages.

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