The AAP is providing guidance on alternatives to amoxicillin oral powder for suspension during a shortage that could last several months.
Several manufacturers are reporting limited supplies of the antibiotic, with some citing increased demand, according to information compiled by the Food and Drug Administration (FDA).
To prevent resistance, clinicians should be sure their patient needs antibiotics before prescribing them. Most infections in children are caused by viruses not bacteria.
If antibiotics are indicated, the AAP Committee on Infectious Diseases recommends pediatricians who can’t find amoxicillin oral powder for suspension first turn to other formulations of amoxicillin such as tablets, capsules or chew tabs. Try to round doses to within 10% of 125 milligrams (mg), 250 mg, 500 mg, 750 mg, 875 mg or 1,000 mg.
Tablets can be split/crushed, and capsules can be opened. Both can be mixed with any liquid or semisolid like applesauce and given orally or by tube. Chew tabs also can be split.
When amoxicillin can’t be used, the following alternatives can be considered.
- Acute otitis media can be treated with amoxicillin/clavulanate or intramuscular ceftriaxone.
- Community-acquired pneumonia or sinusitis can be treated with amoxicillin/clavulanate.
- Group A streptococcus pharyngitis can be treated with penicillin VK, intramuscular penicillin G benzathine x 1 or cephalexin.
- For asplenia prophylaxis, penicillin VK can be used.
A table in the AAP Red Book Online has more information on dosing, duration and other strategies like watchful waiting for some children. The Red Book also has additional alternatives for antibiotic allergies.
Resources
- Information on amoxicillin alternatives from the AAP Red Book Online
- Information on the amoxicillin shortage from the FDA
- AAP policy Antibiotic Stewardship in Pediatrics
- Information on amoxicillin from Pediatric Care Online
- Pediatric Antibiotic Stewardship Program Toolkit
- Information from the Centers for Disease Control and Prevention on antimicrobial resistance
- Information for parents from HealthyChildren.org on the amoxicillin shortage
