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Taking a spoonful of bubblegum-pink amoxicillin is a usual part of being a kid, but a nationwide shortage of antibiotics is making the bad season of sore throats that much more difficult.
It hit home for Caitlin Rivers recently when her two children had streptococcus.
“We had to visit many pharmacies to find the drugs we needed,” says Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “It just adds another burden to what has already been a really difficult winter for families.”
An increase in Strep bacteria
Strep, short for streptococcus;It can cause a bacterial infection that usually leads to a sore throat, fever, and swollen tonsils. It can affect adults, but it is more common in school-age children.
Because the Centers for Disease Control and Prevention does not closely track common Strep infections, it is unclear how many cases there are in the United States right now. But Rivers says cluster node activity has been higher in the past few months than in previous years.
“The whole winter season has been really tough for the common pathogens that keep us out of school and out of work,” Rivers says. “And the sore throat was what was really going on.”
The CDC is tracking a particularly nasty type of bacteria called invasive group A strep.
Invasive streptococcus means that instead of the bacteria staying in the throat, it spreads to other parts of the body, Rivers says. The bacteria can enter the bloodstream or cause a rash on the skin, for example.
And after two years of record low cases of streptococcus infection during the peak of the epidemic in 2020 and 2021, cases are higher than normal this season, according to the CDC.
No matter what type of bacteria someone has, streptococcal infections should be treated with antibiotics.
lack of pink material
The Food and Drug Administration added amoxicillin products to its list of drug shortages in October last year and some are still not available.
The current shortage is limited to pediatric versions of amoxicillin, which are liquid products that are easier for children to take than pills.
The shortage affects several generic brands, such as Sandoz and Teva, but not every product or strength of amoxicillin makes them.
The really common strength of amoxicillin — 400 mg/5 mL — isn’t always available, says Erin Fox, a national drug shortage expert at the University of Utah, but pharmacists have other options.
“You may need to switch,” she says. “So you might have to turn up the volume a little bit… I’ve given the kids antibiotics, and I know it’s no fun, but you can do it.”
She says parents may need to call if their pharmacy doesn’t have what they need. But because amoxicillin is not a controlled substance, pharmacists should be able to get the information and share it with other pharmacies that have it in stock.
Lots of demand
The shortage appears to be due to an ordering issue rather than a quality issue. In other words, there are more people who need the drug than are available.
“Companies usually look to see what their sales were like in the previous year,” says Fox. “They might make some adjustments.” “But with the really intense respiratory season we had this year, it was just a mismatch between what people made and what was available.”
However, under current rules and regulations, pharmaceutical companies don’t actually have to tell the public why something is missing. Not all of them have explained themselves, but based on what some companies have told the FDA, there doesn’t seem to be a problem with manufacturing the drug – for example, contamination in the factory.
Fox says this means drug companies can hope to get forecasts right for next year and make enough. Fortunately, similar to other respiratory diseases, streptococcus bacteria usually reach their peak between December and April, so it may be the end of the season this year.
Although, as epidemiologist Rivers points out, the epidemic has canceled the usual pattern of winter illnesses.
“So I can’t be confident that April will mark the end of sore throat season,” she says, adding that an amoxicillin deficiency may continue to cause problems.