High demand for amoxicillin causing shortages amid child RSV surge

Parents filling their children’s prescriptions might have to try a few pharmacies or end up with a different strength or form than originally prescribed, but amoxicillin in some form is generally still available, pharmacists said. The supply of the liquid version is most strained, along with some chewable tablets.

The flood of demand for the antibiotic reflects the intense surge in RSV that is straining pediatric wards at hospitals across the country as the cold-like virus spreads rapidly among young children, whose immune systems had little exposure to RSV during the first two years of the pandemic.

“This is a sudden demand for amoxicillin that the suppliers were just not prepared for,” said Erin Fox, a senior pharmacy director at University of Utah Health who tracks drug shortages. “Logically, it makes sense. … Colds are going to come back with a vengeance, and people are going to get sick.”

The shortage isn’t at a crisis level and might be short-term, lasting as long as the season of illness does, based on data from manufacturers, said Michael Ganio, senior director for pharmacy practice and quality at the American Society of Health-System Pharmacists.

Still, for now, some may run into snags getting their prescriptions filled. The supply strain comes as doctors brace not only for the RSV surge to continue but also for the spread of flu and COVID-19 to ramp up.

Though amoxicillin does not treat respiratory syncytial virus, or RSV (nor does it work for flu or COVID) it is frequently prescribed for bacterial infections. Children with RSV or the flu can develop symptoms that are hard to distinguish from bacterial infections or can contract a bacterial illness secondarily, experts said, sometimes leading doctors to prescribe amoxicillin just in case.

“That’s why we really are having a run on amoxicillin,” said Tina Tan, a pediatrics professor at Northwestern University’s medical school and a doctor at Lurie Children’s Hospital of Chicago. “Because the viral illness can cause other conditions that look like they might be bacterial, people are putting kids on amoxicillin.”

The American Society of Health-System Pharmacists, for which Fox’s team tracks shortages, first heard reports of potential issues about two weeks ago, Ganio said. The FDA confirmed the shortage Friday, reporting manufacturers citing higher demand.

Pharmacies nationwide have seen the impact of the shortage for the past few weeks, said Brigid Groves, a senior director at the American Pharmacists Association.

“There is some variability among which products they can get,” she said. Anecdotally, pharmacists have reported that patients are “still able to get it, it’s just potentially a little bit more challenging to find.”

Drugmakers have said they can fulfill their preplanned orders for the medicine but are struggling to meet the increased demand. Some said they were looking at whether they could increase production, though that can’t happen instantaneously.

Amoxicillin is commonly used, particularly with children, to treat things like ear infections, strep throat, and urinary tract infections.

Swiss manufacturer Sandoz has hired more workers and added shifts, a spokesperson said, and projects the company will make more than double the amount of amoxicillin next year as it did in 2021. For now, the FDA lists some Sandoz amoxicillin products as unavailable.

“We are facing challenges to meet this sudden spike in demand now that the flu season is here,” a Sandoz spokesperson said in a statement, saying the issue is affecting some of its products in the U.S., Canada, and parts of Europe, and that supply-chain issues also make it harder to ramp up manufacturing quickly.

The manufacturer Hikma has enough supply to deliver amoxicillin orders as planned to its U.S. customers, said spokesperson Steven Weiss. “We understand the importance of this medication and are looking at ways to increase production,” he said.

A spokesperson for CVS said the chain’s pharmacies have seen isolated shortages of some doses of amoxicillin. Walgreens also noted the new demand, but a spokesperson said its pharmacies are keeping up so far.

People filling a prescription can call ahead to confirm whether their pharmacy has the drug, try multiple pharmacies, get a prescription for a slightly different type or, worst-case scenario, get a prescription for a different antibiotic, experts said.

“It’s kind of a shortage of inconvenience,” Fox said. “It’s frustrating when you have an infection and you need to get that antibiotic or get one started for your child; it’s a hassle to have to call around or maybe have to get your prescription switched. But the good news is that there is still product [available].”

It’s unknown how long the RSV surge will last. At Lurie Children’s Hospital of Chicago, where Tan sees patients, the emergency room wait times have gotten significantly longer, the hospital is much more full, and doctors are seeing more RSV, she said.

“It’s going to get worse before it gets better,” Tan said. “It’s hard to say when the surge is going to stop, because the normal respiratory viral season, the pattern that we’re used to, is not there any longer.”