When you take an antibiotic, you expect it to work. But for millions around the world, that’s no longer a guarantee. Antibiotic shortages are no longer rare news-they’re a daily reality in hospitals, clinics, and rural health centers. In 2024, the U.S. FDA listed 147 active antibiotic shortages. Across Europe, 14 countries declared their shortages "critical." And in low-income regions, the problem is even worse: 70% of essential antibiotics are simply unavailable. This isn’t just about empty shelves. It’s about patients dying from infections that should be treatable.
Why Antibiotics Are Different
Most drug shortages hurt-but antibiotics hurt differently. When insulin or blood pressure meds run out, doctors can often switch to another class of drug. Not with antibiotics. If penicillin is gone, and your child has strep throat, there’s no easy substitute. The alternatives are either less effective, more toxic, or both. Take amoxicillin. It’s the go-to for ear infections, pneumonia, and sinusitis. In early 2023, shortages hit hard across the European Economic Area. By the end of the year, use dropped by 69% in hospitals using the combination with clavulanate. What happened next? Doctors turned to broader-spectrum drugs like azithromycin or ceftriaxone. Those are fine for some cases-but overuse pushes bacteria toward resistance. Now, over 40% of E. coli and over 55% of K. pneumoniae are resistant to third-generation cephalosporins. When those fail, the only option left? Carbapenems. And those are already being overused, making them less effective too.The Manufacturing Crisis
You might think drug companies just need to make more. But it’s not that simple. Antibiotics are cheap. Really cheap. The generic market, which supplies 85% of all antibiotics, has seen prices drop 27% since 2015. Meanwhile, regulatory costs for sterile injectables-like penicillin G benzathine-have jumped 34%. That’s a death sentence for manufacturers. Most antibiotics are made in just a handful of factories, mostly in India and China. One shutdown, one inspection failure, or one supply chain disruption-like Brexit-and entire regions go without. The UK saw antibiotic shortages jump from 648 in 2020 to 1,634 in 2023. The European Court of Auditors called it a "systemic failure"-regulators didn’t force companies to invest in backup capacity because the profit margin was too thin. Penicillin G benzathine has been in short supply since 2015. Why? Because it’s a single-dose shot for syphilis and rheumatic fever. It’s not glamorous. It doesn’t make big money. But it saves lives. And now, it’s still hard to find.Who Pays the Price?
In high-income countries, hospitals scramble. Pharmacists spend hours tracking down obscure alternatives. Nurses ration doses. A 2025 survey of U.S. hospital pharmacists found 78% had to change treatment plans in the past year. 62% saw more patients develop complications because they couldn’t give the right drug. One infectious disease specialist in California told a story that’s now common: a young woman with a urinary tract infection. First-line drugs? Gone. She was given colistin-a last-resort antibiotic with severe kidney toxicity. "It worked," she said. "But I felt like I was poisoning her to save her." In low- and middle-income countries, the crisis is deeper. When antibiotics vanish, there’s no backup. No import networks. No stockpiles. A nurse in rural Kenya described sending mothers home with their sick children because penicillin wasn’t in stock. "We know they might die," she said. "But we have no choice." In Mumbai, a mother waited 72 hours for azithromycin to treat her child’s pneumonia. By the time it arrived, the infection had spread. The child ended up in intensive care. These aren’t outliers. They’re the new normal.
The Domino Effect: Resistance and Death
Every time a doctor uses a broader-spectrum antibiotic because the simple one is gone, we lose ground in the war against resistance. The WHO’s 2025 surveillance report found that one in six bacterial infections worldwide are now resistant to first-line antibiotics. For urinary tract infections? That number jumps to one in three. Between 2018 and 2023, resistance rose in over 40% of pathogen-antibiotic combinations. The average annual increase? 5-15%. That’s not slow. That’s accelerating. The Review on Antimicrobial Resistance predicts that without major intervention, antibiotic shortages will grow by 40% by 2030. And with them, 1.2 million additional deaths from infections we used to treat in hours.What’s Being Done?
Some places are fighting back. The WHO launched a $500 million Global Antibiotic Supply Security Initiative in October 2025, aiming to stabilize production by 2027. The U.S. FDA approved two new manufacturing facilities in early 2025-expected to cover 15% of current shortages by Q3 2025. Hospitals are adopting antimicrobial stewardship programs (ASPs). Johns Hopkins cut unnecessary broad-spectrum use by 37% during shortages by using rapid diagnostics to identify infections faster. California created a regional sharing network that reduced critical shortages by 43% across 12 hospitals. But progress is uneven. Only 37% of U.S. hospitals meet all WHO standards for stewardship. And in places without labs, without funding, without trained staff? Nothing changes.
What You Can Do
You can’t fix the supply chain. But you can help stop the cycle.- Never demand antibiotics for colds or flu. They don’t work.
- Take your full course-even if you feel better. Stopping early breeds resistant bugs.
- Ask your doctor: "Is this the right antibiotic?" or "Is there a simpler option?"
- Support policies that fund antibiotic production and improve global access.
What’s Next?
The world is waking up. But not fast enough. The gap between need and supply is widening. Without major investment in manufacturing, better regulation, and global coordination, we’re heading toward a time when common infections become deadly again. We used to think antibiotics were magic. They’re not. They’re a public good. And like clean water or vaccines, they can’t be left to the market. If we don’t act now, the next generation won’t have the tools to treat the infections we take for granted today.Why are antibiotic shortages worse than other drug shortages?
Unlike other drugs, antibiotics often have no safe or effective alternatives. When penicillin or amoxicillin runs out, doctors can’t just switch to another drug in the same class. Alternatives are usually broader-spectrum, more toxic, or less effective-and overusing them speeds up antibiotic resistance. Other medications, like insulin or blood pressure drugs, have multiple substitutes. Antibiotics don’t.
Which antibiotics are most commonly in short supply?
Penicillin G benzathine has been in shortage since 2015 due to manufacturing issues and low profit margins. Amoxicillin and amoxicillin-clavulanate saw major global shortages in 2023. Other critical shortages include ceftriaxone, azithromycin, and carbapenems like meropenem. These are all first-line treatments for common infections like ear infections, pneumonia, and urinary tract infections.
How do antibiotic shortages affect antibiotic resistance?
When first-line antibiotics aren’t available, doctors are forced to use broader-spectrum drugs like carbapenems or colistin. These drugs are more powerful but also more likely to trigger resistance. Overuse of these last-resort antibiotics makes bacteria tougher to kill. The WHO reports that resistance is rising in over 40% of pathogen-antibiotic combinations, with shortages playing a major role.
Why don’t drug companies just make more antibiotics?
Antibiotics, especially generics, are cheap to produce and sell. The market is saturated, and profit margins are razor-thin. Meanwhile, regulatory costs for sterile injectables have risen 34% since 2015. Manufacturers make far more money from cancer drugs or diabetes medications. So they stop producing antibiotics-or only make them in one factory. One breakdown, and the whole world feels it.
Are low-income countries hit harder by antibiotic shortages?
Yes. In low- and middle-income countries, 70% of essential antibiotics are already inaccessible. There’s no backup supply, no import networks, and few resources to switch to expensive alternatives. When penicillin or amoxicillin runs out, patients often go without treatment. This creates a deadly cycle: untreated infections spread, resistance grows, and deaths rise. The WHO calls this a "syndemic"-where under-treatment and resistance feed each other.