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Expert: Using antibiotics judiciously will help maintain supply during amoxicillin shortage, prevent resistance

November 1, 2022

Pediatricians grappling with a shortage of amoxicillin have other antibiotic options but should be judicious in using them to prevent resistance, according to an expert.

“About half of antibiotic prescriptions for acute respiratory tract infections are unnecessary,” Jeffrey S. Gerber, M.D., Ph.D., FAAP, a member of the AAP Committee on Infectious Diseases, said via email. “More judicious diagnosis is critical for reducing overuse.”

His guidance comes as several manufacturers are reporting limited supplies of amoxicillin oral powder for suspension. Some of the companies are citing increased demand, according to information compiled by the Food and Drug Administration (FDA).

“The FDA is aware of some intermittent supply interruptions of amoxicillin products in the U.S., and is currently working with the approved manufacturers,” the agency said in an emailed statement.

Manufacturer Sandoz reported some presentations are available in limited quantity. Other presentations are unavailable, but a limited supply is expected later this year or in early 2023. Aurobindo Pharma and Teva Pharmaceuticals report the antibiotic is available “on allocation,” which the American Society of Health System Pharmacists defines as limited distribution. Hikma Pharmaceuticals has availability for current customers. Rising Pharma is listed as having available product.

Amoxicillin is the recommended antibiotic for infections, including acute otitis media, strep throat, sinus infections and pneumonia, according to Dr. Gerber, a lead author of the AAP policy Antibiotic Stewardship in Pediatrics.

While Dr. Gerber hasn’t seen data verifying an increase in demand, he said the viral respiratory infections that have hit many parts of the country may be mistaken for bacterial infections or occasionally lead to bacterial infections, driving up antibiotic prescribing.

Clinicians should be sure their patient needs antibiotics before prescribing them, Dr. Gerber said. Most infections in children are caused by viruses, not bacteria. If antibiotics are indicated, pediatricians can consider other formulations of amoxicillin not impacted by the shortage. They also can choose another antibiotic depending on the type of infection, age of the child and antibiotic allergies.

“Unfortunately, these are often broader-spectrum antibiotics that we prefer not to use too often. So if the shortage continues, this can drive the development of antibiotic-resistance,” Dr. Gerber said.

The Centers for Disease Control and Prevention estimates there are nearly 3 million antibiotic-resistant infections in the U.S. each year, resulting in more than 35,000 deaths. The agency calls antibiotic resistance “one of the most urgent threats to the public’s health.”

The FDA did not provide an estimate of how long the amoxicillin shortage is expected to last but said it is working with manufacturers to reduce the impact.


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