Antibiotic Shortages: How Drug Shortages Are Putting Infection Treatment at Risk

When antibiotics disappear from hospital shelves, it’s not just a supply chain hiccup-it’s a life-or-death emergency. In 2023, antibiotic shortages affected more than 37 critical drugs globally, with 14 countries labeling them as critical. This isn’t a future scare. It’s happening right now, in hospitals from Wellington to Mumbai, and the consequences are already killing people who should be getting better.

Think about a simple urinary tract infection. For decades, amoxicillin or trimethoprim-sulfamethoxazole fixed it in days. Now, in many places, those drugs aren’t available. Clinicians are forced to use last-resort antibiotics like colistin-drugs so toxic they’re reserved for when everything else fails. One California infectious disease specialist told the American Public Health Association forum she had to prescribe colistin for a routine UTI because first-line options were gone. That’s not innovation. That’s damage control.

Why Antibiotics Are More Likely to Vanish Than Other Drugs

Antibiotics are 42% more likely to face shortages than any other type of medication. Why? Because they’re cheap. The generic antibiotic market, which supplies 85% of all antibiotic use, has seen prices drop 27% since 2015. Manufacturers make pennies per pill. Meanwhile, regulatory costs to produce sterile injectables have jumped 34%. No company wants to invest millions to build a clean room for a drug that barely covers its costs.

Compare that to a cancer drug or a new diabetes pill. Those can cost thousands per dose. Profit margins are high. Manufacturers invest in redundancy, backup suppliers, and quality control. Antibiotics? Not so much. The global antibiotic market grew just 1.2% from 2019 to 2024. The rest of the pharmaceutical industry? Up 5.7%. When money’s tight, companies shut down production lines for low-margin antibiotics first.

Geopolitics makes it worse. Brexit alone pushed the UK’s antibiotic shortages from 648 in 2020 to over 1,600 in 2023. A single factory in India or China that shuts down for regulatory issues can ripple across continents. The U.S. FDA listed 147 active antibiotic shortages in December 2024-the highest in a decade. Europe saw 28 countries affected, with 14 calling it a crisis.

What Happens When Antibiotics Disappear

It’s not just about delays. It’s about worse outcomes. When penicillin G benzathine-the only treatment for syphilis and strep throat complications-wasn’t available in 2023, hospitals had to scramble. Some resorted to oral alternatives that don’t work as well. Others delayed treatment for days. In rural Kenya, nurses told the WHO they sent patients home without treatment, knowing some wouldn’t survive. That’s not a hypothetical. That’s real life.

When amoxicillin with clavulanate vanished in early 2023, use dropped 69% across 16 European databases. Doctors switched to broader-spectrum drugs like ceftriaxone or even carbapenems. That’s a problem. Every time you use a powerful antibiotic unnecessarily, you fuel resistance. Globally, one in three urinary tract infections is now resistant to first-line antibiotics. One in six of all bacterial infections can’t be treated with standard drugs.

And here’s the vicious cycle: shortages push doctors toward stronger antibiotics → stronger antibiotics get overused → resistance grows → fewer drugs work → shortages get worse. It’s a feedback loop no one’s fixed.

The Human Cost: Patients, Nurses, and Doctors on the Front Lines

It’s not just statistics. It’s stories.

A mother in Mumbai waited 72 hours for azithromycin to treat her child’s pneumonia. By the time it arrived, the infection had worsened. Her son ended up in intensive care.

A UK physician on Reddit wrote: “Since Brexit, we’ve had to ration amoxicillin. We’re forced to use drugs we know will make resistance worse.”

In U.S. hospitals, 78% of pharmacists say they’ve changed treatment plans because of shortages. 62% report more patients getting sicker, longer hospital stays, and more readmissions.

Low- and middle-income countries are hit hardest. Seventy percent of antibiotics are already inaccessible in these regions. Add a shortage on top of that, and you get what the WHO calls a “syndemic”-a deadly mix of under-treatment and rising resistance.

Why Alternatives Don’t Always Work

Most drugs have substitutes. If your blood pressure med runs out, you can usually switch to another in the same class. Antibiotics? Not so much.

Take E. coli, which causes most UTIs. Over 40% of strains are now resistant to third-generation cephalosporins-the go-to treatment. When those are gone, the only option left is carbapenems. But carbapenems are broad-spectrum. They kill good bacteria along with bad ones. They’re expensive. They’re toxic to kidneys. And they’re the last line of defense against superbugs.

Using them for a simple infection is like using a sledgehammer to crack a nut. And when you do it too often, the nuts get tougher. Carbapenem-resistant infections are already spreading. In some ICUs, up to 15% of Klebsiella pneumoniae strains are now untreatable with any antibiotic.

There’s no magic backup. No “plan B” that’s as safe, effective, and affordable.

What’s Being Done-and Why It’s Not Enough

Some places are trying. The U.S. FDA approved two new antibiotic manufacturing facilities in January 2025. They’re expected to cover 15% of current shortages by late 2025. The WHO launched a $500 million Global Antibiotic Supply Security Initiative in October 2025, aiming to secure steady production by 2027. The European Commission is pushing new rules to guarantee minimum stockpiles.

Hospitals are adopting antimicrobial stewardship programs (ASPs). Johns Hopkins cut unnecessary broad-spectrum use by 37% during shortages by using rapid diagnostic tests to identify infections faster. That’s smart. But only 37% of U.S. hospitals meet all WHO standards for these programs. Most are underfunded, understaffed, and overwhelmed.

Regional sharing networks, like the one launched in California in 2024, helped reduce critical shortages by 43% among participating hospitals. But these are patches, not solutions. They don’t fix the root problem: no profit, no production.

The WHO wants 70% of global antibiotic use to come from the “Access” group-safe, affordable, narrow-spectrum drugs-by 2030. Right now, it’s only 58%. We’re falling behind.

The Road Ahead: What Needs to Change

Fixing this isn’t about better logistics. It’s about economics. We need to pay for antibiotics like we pay for vaccines-because they’re public health tools, not just commodities.

Here’s what works:

• Guaranteed minimum prices for essential antibiotics so manufacturers don’t lose money.
• Public funding for manufacturing-governments building or subsidizing plants that make critical drugs, not just profit-driven ones.
• Global stockpiles for emergency use, managed by WHO or a similar body.
• Strict limits on overuse-no more prescribing antibiotics for viral infections. No more farm use for growth promotion.
• Investment in rapid diagnostics-so doctors know exactly which infection they’re dealing with before they reach for a drug.

The Review on Antimicrobial Resistance predicts that without action, antibiotic shortages will rise 40% by 2030. That could mean 1.2 million extra deaths a year from infections we used to cure in a week.

This isn’t a problem for pharmacists or policymakers alone. It’s a problem for every person who’s ever taken an antibiotic-or will need one someday. If we don’t fix the system, the next time you get a bad infection, there might not be a pill left to take.

Antibiotics saved millions of lives in the 20th century. But if we keep treating them like disposable products, we’ll lose them for good. The next generation might face a world where a scraped knee or a strep throat could turn deadly-not because the germs are stronger, but because the medicine is gone.