There is a national shortage of amoxicillin suspensions that is anticipated to last several months. See below for alternative therapies during the shortage.
- Preferentially prescribe amoxicillin tablets, capsules, or chew tabs for children able to take these formulations. These have NOT been impacted by the shortage. Attempt to round doses (+/- 10%) to 125 mg, 250 mg, 500 mg, 750 mg, 875 mg, or 1000 mg.
- Products available:
- Tablets: 500 mg, 875 mg
- Capsules: 250 mg, 500 mg
- Chew tabs: 250 mg
- Tablets can be split/crushed to mix with any liquid or semisolid, like applesauce. This can be given orally or by tube.
- Capsules can be opened and mixed with any liquid or semisolid, like applesauce. This can be given orally or by tube.
- Chew tabs can be split.
- When amoxicillin cannot be used, consider the following alternatives:
|
Condition
|
Alternative Antibiotics*
|
Duration and Other Strategies
|
|
Acute Otitis Media
|
- Amoxicillin/clavulanate
- 80–100 mg/kg/day of amoxicillin component (max 2000 mg/dose) divided BID (two times a day)
- IM ceftriaxone as single dose
- 50 mg/kg (max dose: 1000 mg) x 1
|
- Utilize watchful waiting in those over 2 years without severe disease.
- For children 2 years and older, treat uncomplicated (without otorrhea) AOM for 5–7 days.
|
|
Community Acquired Pneumonia
OR
Sinusitis
|
- Amoxicillin/clavulanate
- 80 – 100 mg/kg/day of amoxicillin component (max 2000 mg/dose) divided BID
|
- Consider watchful waiting for persistent upper respiratory tract infection (URI) symptoms >10 days.
- Cefdinir has poor activity against S. pneumoniae.
- Limit treatment to 5 days for pneumonia or 5–7 days for sinusitis.
|
|
Group A Streptococcus Pharyngitis
|
- Penicillin VK
- ≤27 kg: 250 mg BID
- >27 kg: 500 mg BID
- IM penicillin G benzathine x 1
- ≤27 kg: 600,000 units
- > 27 kg: 1,200,000 units
- Cephalexin (if PCN-allergic) 40mg/kg/day (max 500 mg/dose) divided BID
|
- Treat for 10 days.
- Don’t test children that have clear viral symptoms such as cough AND rhinorrhea.
- Don’t test children for group A strep under the age of 3 years unless there is a household member with group A strep pharyngitis.
|
|
Asplenia Prophylaxis
|
- Penicillin VK
- <3 yo: 125 mg BID
- >3 yo: 250 mg BID
|
|
*Additional alternatives for antibiotic allergies listed in the AAP Red Book Systems-Based Table.
Resources:
Expert: Using antibiotics judiciously will help maintain supply during amoxicillin shortage, prevent resistance | AAP News | American Academy of Pediatrics
FDA Drug Shortages for Amoxicillin
Drug Shortage Detail: Amoxicillin Oral Presentations (ashp.org)
Systems-based Treatment Table | Red Book: 2024–2027 Report of the Committee on Infectious Diseases | Red Book Online | American Academy of Pediatrics (aap.org)
Red Book Online | American Academy of Pediatrics (aap.org)
With a shortage of the antibiotic amoxicillin, what if my child needs it? Is there a replacement? | HealthyChildren.org
