Why antibiotics keep running short

Cefotaxime, an injectable antibiotic used in hospitals, went onto FDA's shortage list on Feb. 17, 2015. It is still there. On Oct. 30, 2026, FDA's listing marked it unavailable, and in GxRadar's tally of the agency's Drugs@FDA records¹¹, all 14 generic applications FDA ever approved for cefotaxime sodium now carry discontinued status.

Cefotaxime is the oldest antibiotic entry on the current list, but it has company. Seven anti-infective drugs were listed as currently in shortage on that date, according to GxRadar's analysis of the openFDA drug shortages data¹. Anti-infectives were also the largest single category among the 161 entries FDA had marked "to be discontinued," with 30.

Antibiotics fit most of the risk factors federal researchers have tied to shortages. Many are decades old and off-patent, they sell for little, and the hospital ones are often sterile injections made by a handful of companies. The research record on antibiotic shortages goes back more than a decade, and so do the economics behind it.

What is on FDA's list now

Source: GxRadar analysis of openFDA drug shortage records with status "Current" as of Oct. 30, 2026; years counted to Nov. 3, 2026. FDA's shortage FAQ² notes that an available status "is not an FDA determination that the shortage has been resolved."

Five of the seven are injections or IV powders. Three of the seven are marked unavailable, a higher share than for the list as a whole. Amoxicillin, short in 2022 and 2023, is no longer listed; that episode is covered in The amoxicillin shortage of 2022 and 2023. All current listings are on our shortage tracker.

A long record of antibiotic shortages

Antibiotic shortages predate today's list by decades. A 2015 study in Clinical Infectious Diseases³, using the University of Utah Drug Information Service database, counted 148 antibacterial drugs that went into shortage from 2001 to 2013, with a median of 10 new shortages a year. The median shortage lasted 188 days, 22 percent of the drugs went short more than once, and the number on shortage rose steadily from mid-2007 through 2013. The authors singled out drugs for multidrug-resistant infections as a particular concern.

Anti-infectives have stayed prominent since. An HHS white paper from April 2024⁷ put anti-infectives at 12 percent of the 123 drugs in shortage in January 2024. GxRadar's breakdown of today's list is in FDA's current drug shortages, by therapeutic area.

Why cheap antibiotics run short

FDA's 2019 root-cause report⁵ found that of 163 drugs that went into shortage from 2013 to 2017, 63 percent were injectables and the median time since first approval was almost 35 years. In the year before the shortage, the median price per unit was $11.05 for the injectables and $2.27 for oral drugs. The report's headline finding was that "economic forces are the root causes" and that shortages persist because they "do not appear to resolve according to the 'textbook' pattern of market response," where higher prices draw in more supply.

FDA's FAQ² describes the injectable problem directly. With "fewer firms making older sterile injectable drugs, there are a limited number of production lines," so when one company stumbles the rest struggle to fill the gap. That pattern is covered at more length in Why sterile injectables dominate shortage lists. An HHS analysis from December 2024⁸ counted an average of five manufacturers per molecule for generic injectables against nine for oral generics, and found that 70 percent of recently launched generic injectables had not turned a profit by their third year.

Oral antibiotics are cheap too, though they are short less often. GxRadar's analysis of CMS NADAC survey data¹⁰ shows what retail pharmacies paid per unit for six common generic antibiotics. NADAC covers drugs bought by retail pharmacies, so it says nothing about hospital injectables, but it shows how little money each pill carries.

Source: GxRadar analysis of CMS National Average Drug Acquisition Cost files, monthly averages. NADAC is a survey of pharmacy purchase prices and is not what a patient pays. Doxycycline and nitrofurantoin started high because of the 2013 price spikes described in Nitrofurantoin and the antibiotic price story.

Penicillin G benzathine, a one-product market

Penicillin G benzathine, the long-acting injection used to treat syphilis, shows how thin some antibiotic markets are. A December 2024 FDA presentation⁹ said only one FDA-approved penicillin G benzathine injectable suspension was marketed in the US, that the shortage began April 26, 2023, because demand outpaced supply, and that demand had grown with rising syphilis rates. When FDA asked regulators abroad, most countries also turned out to rely on the same source.

In November 2023 FDA posted a letter to clinicians⁶ announcing the temporary import of a version marketed in France, which is not FDA-approved, and the 2024 presentation lists a second imported product. FDA's wider shortage process is covered in How FDA tracks drug shortages. GxRadar's ANDA tally lists no approved generic application for penicillin G benzathine. On Oct. 30, 2026, the injection was still listed as current, with limited availability. Why some drugs end up with a single supplier is the subject of Why some generics have only one maker.

When makers leave

Of the 30 anti-infective entries on FDA's to-be-discontinued list on Oct. 30, 2026, 20 were antibacterial drugs and 14 of those were injections, among them vancomycin, ceftriaxone, cefepime, piperacillin and tazobactam, daptomycin and cefazolin in dextrose. The rest were antifungals, antivirals and antiparasitic drugs.

Those entries come from manufacturers' notices about their own products. FDA's FAQ says the discontinuations on its database "reflect information received from manufacturers and are for informational purposes only." GxRadar's count of approved generic applications not in discontinued status, from Drugs@FDA¹¹, still shows 36 for vancomycin hydrochloride, 21 for daptomycin, 16 for piperacillin and tazobactam, 14 for ceftriaxone sodium and five for cefepime hydrochloride, across all dosage forms. Approvals are not the same as active production. Even so, at least 10 of the antibiotic and antifungal injections with discontinuation notices are drugs FDA put on its 2020 list of essential medicines¹² in IV form; what became of that list is told in FDA's essential medicines list, and what happened to it.

What shortages change at the bedside

A 2016 survey of infectious disease physicians⁴, published in 2018, drew 701 responses from 1,597 members of a national network. Seventy percent said a shortage had forced them to change their antibiotic choice in the prior two years. Of those reporting an effect on patient care, 75 percent cited use of broader-spectrum drugs, 58 percent more costly drugs, 45 percent less effective second-line drugs and 37 percent more toxic drugs. The drugs they most often reported in short supply were piperacillin and tazobactam, ampicillin and sulbactam, meropenem, cefotaxime and cefepime.

The 2015 study's authors flagged shortages of drugs for multidrug-resistant infections in particular, citing limited treatment options. Patients who are told an antibiotic is short can ask their pharmacist or prescriber what alternatives exist and how they differ; a fuller list of questions is in What to ask when your medicine is in shortage.

Next on the calendar is one manufacturer's imipenem and cilastatin injection, a broad-spectrum hospital antibiotic, which its FDA listing says is to be discontinued around Nov. 30, 2026.