High-dose amoxicillin is the first-line therapy for acute otitis media (AOM) — the most common indication for antibiotics in children. On October 28th, 2022, the US Food and Drug Administration (FDA) announced a national shortage of amoxicillin liquid suspension. Outbreaks of seasonal respiratory viruses starting in autumn 2023 have increased demand; however, most manufacturers did not disclose a reason for the shortage or resolution timeframe. More broadly, the extent to which drug shortages affect prescribing patterns has not been well-characterized. The American Academy of Pediatrics recommended various alternatives to treat AOM, including splitting tablet or capsule formulations, use of traditionally second-line agents, and watchful waiting.

To characterize the causal impact of an unexpected shock to medication availability, we performed a quasi-experimental analysis of antibiotic prescribing for uncomplicated AOM. We hypothesized that amoxicillin prescribing would immediately decrease alongside greater use of broader-spectrum antibiotics and a gradual...

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