Support for primary care providers regarding antibiotic medicine shortages

Therapeutic Guidelines updates ‘Antibiotic prescribing in primary care summary table’ with temporary advice on alternative recommendations to first-line antibiotics for use in shortage situations. 


Following the COVID-19 pandemic, several antimicrobials used to treat infections in primary care are in short supply, causing significant challenges in practice with implications for patient safety and antimicrobial stewardship. 


Consulting with the Department of Health and Aged Care and the Therapeutic Goods Administration, Therapeutic Guidelines has engaged the Antibiotic Primary Care Expert Group to develop temporary advice on alternative recommendations to first-line antibiotics for use in shortage situations. This information has been added to the freely available primary care summary table on the Therapeutic Guidelines website. The main aim of the primary care summary table is to support antimicrobial stewardship in primary care and the table continues to highlight infections for which symptomatic treatment alone is often appropriate. 


Shortage of oral liquid formulations of some antibiotics is particularly an issue. To enable the preferred antibiotic to be used in children when an oral liquid formulation is not available, the summary table also includes temporary advice developed by The Society of Hospital Pharmacists of Australia, from Don’t Rush To Crush, on the suitability of crushing or dispersing oral solid-dose formulations. 


The alternative antibiotics included in the primary care summary table should only be considered if first-line treatment is unavailable as the alternatives may be less efficacious, have a suboptimal spectrum of activity and have a less favourable harm–benefit profile. Alternative antibiotics for each condition are listed in order of preference based on antimicrobial stewardship principles; the decision on which alternative antibiotic to use in an individual patient depends on availability and patient-specific factors. 


For second-line treatment options outside of a shortage situation and management of special patient groups (e.g. penicillin hypersensitivity, renal impairment), see Therapeutic Guidelines.