US Drugmakers Depend on Chinese Supply Chains for Key Antibiotics

September 2, 2026 at 06:48 PM2 min

This digest was compiled by AI from multiple sources — links to the originals are below.

China controls over 70 percent of antibiotic active ingredients imported by the United States, leaving few backup suppliers for widely used drugs like amoxicillin and azithromycin. The dependence is drawing attention as Chinese leader Xi Jinping is expected to visit Washington, D.C. on September 24 for a state visit. The report by Scalare Advisors highlights that a single Chinese company, CSPC Pharmaceutical Group, produces both amoxicillin and azithromycin for the U.S. market.

Key Facts

China supplied more than 70 percent of antibiotic active ingredients by volume imported into the United States in 2024.
CSPC Pharmaceutical Group produces both amoxicillin and azithromycin for the U.S. market, controlling the fermentation-to-tablet chain for two of the three dominant outpatient antibiotics.
Bristol-Myers Squibb closed its last U.S. penicillin fermentation plant in 2004, eliminating domestic production of 6-aminopenicillanic acid.
China now makes about 90 percent of the world's penicillin ingredient.
Pfizer has one heparin injection product on the FDA's active shortage list.

Antibiotic Supply Concentration

Three of the most commonly used outpatient antibiotics in the United States—amoxicillin, azithromycin, and ciprofloxacin—depend on Chinese-made active ingredients. A simultaneous disruption in all three would leave doctors with no reliable outpatient antibiotic option obtainable at the necessary scale and speed. CSPC Pharmaceutical Group, a Chinese conglomerate, produces both amoxicillin and azithromycin for the U.S. market. No equivalent domestic or allied producer exists for either drug.

Penicillin Production Loss

Bristol-Myers Squibb announced the closure of its last U.S. penicillin fermentation plant in 2004 and ended production the following year. The closure eliminated domestic manufacturing of 6-aminopenicillanic acid, the building block for penicillin-class drugs used to treat strep throat, ear infections, pneumonia, and Lyme disease. No U.S. plant currently produces penicillin from scratch. China now makes about 90 percent of that ingredient worldwide.

Heparin Shortage Risk

Heparin, one of the most commonly used blood thinners, illustrates the same supply chain pattern. Pfizer has one heparin injection product on the Food and Drug Administration's active shortage list. The two remaining U.S. heparin suppliers rely on Chinese-sourced raw material.