Amoxicillin Shortage Being Felt at Pharmacies and Pediatrician Offices Across South Florida

The U.S. Food & Drug Administration (FDA) confirmed recently that the country is experiencing a shortage of the antibiotic amoxicillin, particularly in the oral suspension and chewable tablet forms most often prescribed for young children.

Resource editors spoke about the shortage with two experts from Baptist Health: Madeline Camejo, MS, PharmD, vice president and chief pharmacy officer, and Timothy Gauthier, PharmD, the health system’s antimicrobial stewardship clinical manager.

Resource: Dr. Camejo, what’s behind the shortage of amoxicillin, and how long might it last? 

Dr. Camejo: Amoxicillin is used for bacterial infections and is usually prescribed as secondary protection for ear infections or pneumonia. No one knows how long it will last but there are a couple of reasons for the shortage. In general, antibiotics are generic drugs that have existed for years. They tend to be cheaper and have lower profit margins than the newer drugs. That means drug companies have a lot less incentive to set up robust, resilient supply chains and they may be caught short if something goes wrong at a competing supplier or there is an increase in demand, which is what is happening now. In the last couple of months, there has been a big increase in demand in the U.S. pediatric space due to the sharp rise in cases across the country of respiratory syncytial virus, or RSV. For now, suppliers are trying to keep up with the demand but they have placed limits on how much pharmacies can order. 

Resource: Should we – and especially parents of young children – be worried? 

Dr. Camejo: No, but when you’re seeing your pediatrician urge them to keep the shortage in mind and consider other options. They could write prescriptions specifying that the preference is for a particular dose of amoxicillin, but if that isn’t available, include alternative dosing or the option of switching to a different antibiotic.

Resource: Can amoxicillin still be found locally? 

Dr. Camejo: Yes, but it’s a good idea to have your pediatrician’s office call your pharmacy before they write the prescription to make sure what types of doses they have available.

Resource: Is Baptist Health being affected by the shortage? 

Dr. Camejo: At this time, we have a healthy supply in the system but suppliers have put us on allocation, limiting the amount we can order for replenishments.

Resource: Is amoxicillin available at Baptist Health retail pharmacy locations? 

Dr. Camejo: Yes, and it is also available in our InstyMeds (Rx Now) prescription medicine dispensing machines, which can be found in all of our Baptist Health Urgent Care locations and in a number of our ERs.

Resource: Dr. Gauthier, why is amoxicillin so widely prescribed, especially for children? 

Dr. Gauthier: Amoxicillin is in the “penicillins class” of antibiotics and are some of the safest and most effective antibiotics in existence today. For this reason, the penicillins are first-line antibiotics for many types of bacterial infections in both adults and children. Bacterial pharyngitis and moderate-severe acute otitis media are two reasons amoxicillin is prescribed for children. 

Resource: Are there any alternatives to amoxicillin that are equally effective? 

Dr. Gauthier: Antibiotic selection is complex but in general the answer is yes. After determining someone has a bacterial infection requiring antibiotics, you then need to consider things such as: (1) which antibiotics can kill the target bacteria, (2) which antibiotics reach the site of the infection once absorbed into the body, and (3) what patient-specific factors make my options acceptable or not (e.g., kidney function, drug interactions, allergies or patient preferences). Oral penicillin, ampicillin, amoxicillin-clavulanic acid, cephalexin and cefadroxil are just a few potential options depending on the answers to these questions. 

Resource: Do those have any side effects people should look out for? 

Dr. Gauthier: Every antibiotic has its own set of risks. That can be toxicity, drug interactions, collateral damage on the patient’s microbiome from the antibiotic, or something else. As a general rule, penicillin-type antibiotics – and beta-lactam antibiotics as a larger family, including the penicillins – are among the safest and most effective antibiotics available. Virtually all antibiotics can cause nausea, vomiting, upset stomach and diarrhea. Licensed healthcare professionals such as pediatricians are best able to identify a reasonable alternative for a specific pediatric patient should an order for amoxicillin be unable to be filled due to lack of availability. 

Resource: What about old or unused amoxicillin in the household from a previous illness – is it safe to use? 

Dr. Gauthier: Antibiotics should never be taken unless indicated. All antibiotics come with risks, including the risk of an allergic reaction or the risks associated with the impact of antibiotics on a person’s microbiome. When they are indicated, however, we need to make sure patients are getting the right drug, via the right route, at the right dose and for the right duration. Even if you have the right drug, and the antibiotic is truly indicated, an expired medication may not give the right dose, as the active ingredients can degrade over time. As a general rule, it is a very bad idea to share antibiotics in the home or use leftover pills from an old prescription. 

Dr. Gauthier: Antibiotics should never be taken unless indicated. All antibiotics come with risks, including the risk of an allergic reaction or the risks associated with the impact of antibiotics on a person’s microbiome. When they are indicated, however, we need to make sure patients are getting the right drug, via the right route, at the right dose and for the right duration. Even if you have the right drug, and the antibiotic is truly indicated, an expired medication may not give the right dose, as the active ingredients can degrade over time. As a general rule, it is a very bad idea to share antibiotics in the home or use leftover pills from an old prescription.