- The US is facing a shortage of amoxicillin, a commonly-prescribed antibiotic.
- The shortage primarily affects amoxicillin oral powder for suspension, a liquid form of the antibiotic typically given to children.
- Unseasonal surges of flu and RSV cases may be linked to the shortage due to an increase in demand for the drug.
The US is facing a shortage of amoxicillin, one of the most commonly prescribed antibiotics, as cases of respiratory illnesses continue to rise across the country.
The US Food and Drug Administration (FDA) announced the shortage—which specifically applies to the liquid form of amoxicillin commonly prescribed to kids for everything from ear infections to strep throat—late last month.
The agency cited an increased demand for the drug as the reason for the short supply.
“Amoxicillin is a go-to agent for pediatric infections,” Michael Postelnick, RPh, BCPS, senior infectious diseases pharmacist and system program director of Antimicrobial and Diagnostic Stewardship at Northwestern Medicine, told Health. “But nobody should be panicking because we are at the point now where there is still some amoxicillin out on the market.”
Short Supply of Amoxicillin, but Alternatives Exist
Amoxicillin oral powder for suspension, the specific form largely in short supply, is the liquid form of the antibiotic; the powder is meant to be mixed in-pharmacy with water. Because children typically have a hard time swallowing capsules, this is the form that’s usually prescribed in pediatric cases.
But amoxicillin comes in other forms as well—including capsules, tablets, and chewable tablets—which haven't been hit by the shortage quite as hard.
According to Jill Foster, MD, division director of the division of pediatric infectious diseases at the University of Minnesota Medical School, one alternative to amoxicillin in liquid form could be a chewable tablet or an opened amoxicillin capsule or crushed pill.
“It tastes bitter and it’s going to create more challenging situations for parents,” Dr. Foster told Health, but it is an option.
There are also drugs called broad-spectrum antibiotics, which can target the same bacteria that amoxicillin kills—but that solution presents its own challenges.
According to Postelnick, a key advantage of amoxicillin is the fact that it’s targeted. That means it attacks the bad bacteria causing an infection without destroying good bacteria. This pointed attack also creates less opportunity for drug resistance.
The World Health Organization (WHO) recognizes antimicrobial resistance—that is, bacteria that have evolved to resist treatment with existing antibiotics—as one of the top 10 issues threatening global health. Drug resistant bacteria kill 35,000 Americans every year, according to the Centers for Disease Control and Prevention (CDC).
Many of the antibiotics that can be used in place of amoxicillin are broad-spectrum antibiotics, which are less targeted and can create opportunities for bacteria to become resistant. This is why they aren’t typically the first line of defense against bacterial infections that amoxicillin alone can treat.
“These bugs that are out there in children are becoming more and more resistant because of the amount of antibiotics we are using," said Dr. Foster. "Prescribing something with a broader spectrum encourages more resistance and then you have a lot fewer choices of antibiotics."
But in a pinch, these antibiotics can be prescribed until the shortage eases.
“If there's a real need for a child to get an antibiotic, these alternatives come with some slight increased risk, but they are active and will be effective,” said Postelnick.
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RSV, Influenza Linked to Increased Demand
The US is in the midst of a surge in RSV and influenza infections, which are particularly impacting kids. Although antibiotics do not treat viral infections, they are often prescribed when someone has a viral infection—but that doesn’t mean it’s always necessary.
According to Postelnick, people do sometimes develop secondary infections, or a bacterial infection that occurs after or at the same time as a viral infection. Since both bacterial and viral infections can produce the same symptoms, it can be difficult to discern between the two, Postelnick said, so doctors often prescribe antibiotics just in case a person also has a bacterial infection.
“But study after study has shown the low probability of secondary bacterial infections,” Postelnick said.
Amoxicillin is used to treat pneumonia, which can affect a small percentage of children who have RSV. However, if a child is hospitalized with pneumonia, the shortage should not affect them—in that case, the chid would receive the drug intravenously.
As far as the shortage of liquid amoxicillin prescribed to outpatients, a cultural issue is likely driving the supply issue, according to Dr. Foster. “A lot of parents come in expecting an antibiotic,” she said, so physicians will often prescribe one even if it isn’t necessary.
The most recent CDC data reported that around 30% of outpatient antibiotic prescriptions are unnecessary. Dr. Foster believes the temporary shortage could present an opportunity to cut back on unnecessary antibiotic prescriptions, but the situation is challenging.
“It’s tough out there for physicians. Everyone is inundated with patients and now we’re saying, ‘You’re inundated and now we want you to stop and have a longer conversation with parents about why they don’t need antibiotics,’ and nobody has time to do that,” she said. “So what is probably happening is physicians are saying, ‘Fine here is the prescription.’”
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Supply Issues Expected to Be Short-Lived
Some suppliers expect to have limited supply for some dosages as far out as March 2023, and many have planned resupplies rolling out before then, according to data from the American Society of Health-System Pharmacists, a professional organization that tracks drug shortages.
One company, Teva Pharmaceuticals, expects to have additional amoxicillin in one dosage—200 mg per 5 mL, in 75 mL and 100 mL bottles—available by mid-November. Higher dosages aren’t expected until February 2023.
Postelnick cautions that these are estimates, and it's unclear exactly when the shortage will ease.
“We’ve dealt with drug shortages for years," said Postelnick. "These estimates for availability are not super accurate, but this is what the drug companies are saying and this is the best information we have."