Israeli Hospitals Weigh Usage of Crucial Antibiotic Amid Global Shortage

Explosion in Chinese factory disrupted supply chain, but Israeli physicians hope they bought enough to last the lean months.

Ichilov Hospital in Tel Aviv.
Aviad Herman

A worldwide shortage of a crucial antibiotic has reached Israel and is beginning to be felt in its hospitals.

Tazocin, a broad-spectrum antibiotic usually administered intravenously, is widely used both in Israel and abroad to treat infections in hospitals, especially in intensive care units. Sometimes given in combination with other antibiotics, it is effective against a wide range of infections, including many that arise as complications of other medical problems.

Inter alia, it is used to treat cystic fibrosis, pneumonia, urinary tract infections and life-threatening infections in cancer patients. It is also used to prevent infections during complicated surgeries.

“We aren’t yet facing a critical shortage” of Tazocin, said Dr. Ronen Ben-Ami, head of the infectious diseases unit at Ichilov Hospital in Tel Aviv. “But we’re already carefully weighing its use, because it’s an important medication.”

Tazocin is actually a combination of two drugs – piperacillin, an antibiotic of the penicillin family, and tazobactam. The latter inhibits the action of beta-lactamases, which are enzymes that help bacteria resist antibiotics by breaking down the antibiotic’s structure. The combination thus makes Tazocin especially effective against a wide range of bacteria.

“We use this drug to treat lung infections in patients on respirators, pneumonia, infections caused by the use of catheters, urinary tract infections and more,” Ben-Ami said. “Additionally, there are oncology patients who get infections after chemotherapy, and for them, this medicine is the first line of defense. This antibiotic is a kind of workhorse for treating hospitalized patients.”

No other drug is an exact substitute, he added, so the shortage will force doctors to choose between a narrow-spectrum antibiotic, which would be less effective, or a stronger drug of the kind that are usually kept as a last resort.

“If we reach a critical shortage, as has already happened in several countries, the price may be that we’ll have to treat with very broad-spectrum drugs – drugs we save as a last resort,” Ben-Ami said. “Giving these drugs in situations where they aren’t essential could cause the appearance of additional antibiotic-resistant bacteria and undermine the effectiveness of the most important and effective class of medicines against antibiotic-resistant infections.”

Dr. Ronen Loebstein, director of the Institute of Clinical Pharmacology and Toxicology at Sheba Medical Center in Tel Hashomer, said the Tazocin shortage in Israel isn’t yet serious, “because we found about it in time and bought enough to last several months. At the moment, we aren’t using alternative drugs, in the hope that our inventory will suffice. But if the crisis lasts longer than expected, we’ll have to look for alternatives. They do exist, but unfortunately, they’re more expensive.”

The Health Ministry said in a statement that to cope with the temporary shortage, it has approved the import of an alternative antibiotic “that includes an identical combination of active ingredients.”

“At this stage, we’re unaware of any shortage that doesn’t have a solution,” the statement added.

The British paper The Guardian reported that the supply problems began in March, due to an explosion at a Chinese factory where the raw materials for Tazocin are produced. The British health authorities have ordered British hospitals to limit their use of the drug, the report added, and to use alternative antibiotics as much as possible so as not to run the existing stock of Tazocin down to dangerous levels.

Sources in the British health system told The Guardian that this is one of the most severe drug shortages the country’s National Health Service has ever had to deal with. Some British hospitals said their supply of the drug had already run out.

The Chinese factory has already resumed production, the paper said, but the global supply chain isn’t expected to fully recover for another several months.