SA running out of penicillin

Picture: Sonqoba Kunene
Picture: Sonqoba Kunene

Pietermaritzburg - A new crisis has hit the medical fraternity after information revealed a national shortage of penicillin.

This comes on the heels of recent reports which exposed a shortage of antiretrovirals (ARVs) in KwaZulu-Natal.

The Witness can reveal that doctors have warned that the shortage of penicillin in the country could lead to a spike in cases of “super bugs” as broader spectrum antibiotics are used instead.

South African Medical Association senior official Dr Mark Sonderup said there was a clear shortage of medication in South Africa, with the “most alarming” being injectable penicillin.

“Together with the shortage of ARVs in certain provinces, I would term this a crisis.”

Sonderup said benzylpenicillin has been unavailable since February this year.

“This may relate to a global shortage of ingredients for benzylpenicillin; however, we are unsure why there is an API [ingredient] shortage.

“Clinics and hospitals are using ampicillin as an alternative. It is similar to penicillin, but has a different compound, but we are effectively running out of that too,” he said.

Sonderup said the reasons for ampicillin shortages in South Africa were “unclear”, as there had been a global problem with ingredients but it had been fixed in February this year.

“We are effectively running out of penicillin in South Africa.

“One of the cornerstones of ARVs is uninterrupted treatment. We are forcing people to be non-compliant with taking their medication because it is not available.”

Sonderup said although there seemed to be a sufficient supply of the fixed-dose ARVs, the problem lay with the supply of single-dose ARVs.

Fixed-dose ARVs were comprised of three different tablets in one.

He said some people were intolerant or did not respond to the “first line” or fixed-dose ARV and needed alternatives such as Abacavir, which were dosed separately.

“That is where the shortages come in,” said Sonderup.

“ARVs are the tip of the iceberg. The problem is a bit more serious and broader than it appears,” Sonderup added

A nurse at a Pietermaritzburg clinic, who would not be named, said there had been a shortage of ARVs since February this year and the problem was yet to be resolved.

The nurse said the district was waiting on a contingency plan from the Department of Health and were therefore “shocked” to hear the National Health Department say there was no problem.

“We don’t know what to do. There are no ARVs for children or adults and we are forced to turn them away.

“It seems as if the people at higher levels do not want to accept that there is a problem, and those who are on ground level have to bear the brunt,” said the nurse.

The back-up option of administering HIV-positive children with a “second line” of drugs also abruptly ended when the clinic’s supply of the more toxic medicine ran out.

“These children, who are dependent on ARVs, have not taken the medication since February. Their bodies will become resistant to the meds and when the ARVs do arrive they will be useless.

“Their viral load will be too high for the ARVs to assist,” said the nurse.

She said their clinic had been informing patients that there was no supply of medication and asked them to call regularly to check if the drugs had arrived.

Circulars distributed by the provincial Health Department around state hospitals and clinics in January and leaked to The Witness, state: “We currently have limited supply of Efavirenz 50 mg and Abacavir solution 20 mg due to supplier problems.”

The nurse said the shortages have persisted since the circular was issued.

A national medicine shortages catalogue released on the national Health Department’s website in April this year listed the medications with supplier constraints, and API shortages with different forms of penicillin and ARVs were included.

‘Stop squabbling about it and fix it’

Treatment Action Campaign spokesperson Patrick Mdletshe said instead of politicians disputing the medicine shortage, they should work to fix it.

“We want to know what the strategy is; what is their plan B? How do they plan on monitoring the situation and how will they make sure the clinics and hospitals receive the necessary medication?

“If the medication is not available in the hospitals, they will not be available in clinics, and the clinics service more people than hospitals.

“Instead of squabbling about it, we need to fix it,” he said.

‘I can assure you there’s no shortage’

National Health Department spokesperson Joe Maila said the national medicine shortages catalogue list did not mean there was a shortage of particular medicines because it was a “precautionary catalogue”.

“The catalogue is to show people where there might be a shortage, so they know if there is a real problem. They need to know what the alternatives are,” said Maila.

“There are no shortages of ARVs at all at a national level. We keep 10% of our stock in case there is a shortage.

“I can assure you there is no shortage. There is not even a shortage in KZN,” he said.

Asked about the penicillin shortage, Maila said he was not aware of the issue and had to confirm with the department.

Health MEC Sibongiseni Dhlomo said the province was following a national plan to solve the shortages of medication in KZN.

He was also unaware of a shortage of penicillin

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