The Food and Drug Administration recently reported a shortage in liquid amoxicillin, an antibiotic that fights bacterial infections in infants and toddlers.
One of the most common antibiotics that pediatricians prescribe babies and children is amoxicillin, which treats bacterial infections. On October 28, 2022, the Food and Drug Administration (FDA) reported a shortage of "oral powder for suspension," a powder that's mixed into liquid form before use and can be life-saving medication for young children.
"Taking care of a newborn is hard enough,” says Nur Afsar, M.D., board-certified OB-GYN and new mother. "Just imagining her unwell and crying inconsolably all day breaks my heart. As a physician, I understand the shortage and prevention of antibiotic resistance, but as a mom I just wouldn’t be able to handle her pain and hope there’s a remedy soon."
She's hardly alone. Parents across the country rely on the drug to treat common ailments like strep throat, sinus and ear infections, amongst other things, though it is important to note that amoxicillin and similar antibiotics do not work against viral infections.
Antibiotics are generally very safe medications for children and most children start to feel better between 48 to 72 hours of starting treatment. It is recommended that the medicine is administered through the prescribed length of time even if the child appears to feel better. But like all medications, they can cause side effects or other problems. Side effects may include allergic reactions (though rare) and lesser common side effects like diarrhea, nausea, and stomach pain. In spite of these potential side effects, most pediatricians will still prescribe antibiotics, as necessary. Usually, a pediatrician will make sure that the child is suffering from a bacterial infection by looking for certain symptoms such as prolonged fever, runny nose, cough, or a sinus pressure or headache with chills over a period of a few days.
When it's clinically necessary to prescribe antibiotics, a shortage of an integral one like amoxicillin can have devastating impacts for those children that desperately need it. Experts are pointing to high demand due to an early intense illness season as one possible reason. There's been a recent uptick in respiratory syncytial virus (RSV) in babies throughout the U.S., and although amoxicillin does not treat the virus, doctors may still prescribe it because symptoms can be confused as those of a bacterial infection. Or the antibiotic is prescribed as a preventative since RSV can lead to secondary bacterial infections, the Washington Post reports.
"As a parent of young children and a pediatrician, we are facing a tsunami of viral illness ever since school started this year, and the illnesses just keep on coming," notes Hina Talib, M.D., board-certified pediatrician and adolescent medicine specialist. "Most viruses that cause these cough and cold symptoms are treated by using supportive care measures like steam and rinses but young children may also face a bacterial ear infection, sinus infection, pneumonia, or strep throat, and they may potentially need an antibiotic like amoxicillin."
Pediatricians and parents are concerned about the impact that a lack of available amoxicillin will have should their child be suffering from a bacterial infection. "Medication shortages, delays in getting access to testing, and the recent news about the wait times and lack of hospital beds for pediatric patients seeking urgent or emergency care during this RSV and flu viral surge is intensely upsetting to parents and pediatricians," says Dr. Talib.
However, parents can be reassured that there are other options in the event amoxicillin is proving difficult to secure. "If a child needs this antibiotic to treat a bacterial infection, we do have options. The Children's Hospital of Philadelphia created a clinical pathway to help pediatricians with alternative approaches to help treat the child," says Dr. Talib. "Sometimes pediatricians will employ the 'wait and see' approach to ensure they are not unnecessarily treating a viral infection with an antibiotic."
An unforeseen advantage of the shortage is that it forces pediatricians to rule out a viral infection. "We do worry that we may be unnecessarily treating a viral infection with an antibiotic and a silver lining of this shortage and the attention it brings to pediatric care, is to remind us all to be good stewards of prevention of antibiotic resistance by not over-using antibiotics," Dr. Tilab explains.
If it is confirmed that a child is indeed suffering from a bacterial infection, then the pediatrician also has the option to call other local pharmacies in the area to check if they have a supply. If that's possible, then a prescription can be transferred over.
Hopefully the shortage is only short-lived and supply is resumed, but in the meantime, perhaps the scarcity of amoxicillin comes at a time where medical professionals can take time to assess whether antibiotics are truly a requirement for recommended treatment.