Why is there a shortage of liquid formulations of oral antibiotics?
There are multiple contributing factors, but the biggest one is a surge in demand related to an increased prevalence of upper respiratory tract infections. Antibiotic overuse for viral respiratory tract infections, including infections caused by respiratory syncytial virus (RSV) and influenza, contributes to drug shortages.
What antibiotics are on shortage?
The shortage is primarily impacting liquid formulations and chewable forms of antibiotics. Supply limitations of amoxicillin, amoxicillin-clavulanate (Augmentin), cefdinir (Omnicef®), cefpodoxime, cephalexin, clindamycin, and penicillin have been reported. Supply of specific medications may vary significantly at different pharmacies.
What should I expect if my child is evaluated for a cold, sore throat, and/or ear pain?
The overwhelming majority of respiratory tract infections are caused by viruses and do not need antibiotics, which only treat bacteria. Antibiotics do not help in these cases, and giving unnecessary medications places children at risk for antibiotic side effects and will worsen an already critically low supply of life-saving medications.
Here are a few reminders related to antibiotic use in respiratory tract infections:
Strep Throat
- Antibiotics should be given for strep throat only when a child has a positive test for group A Streptococcus
- Some children should not be tested for group A Streptococcus because their age and other symptoms rule out this infection:
- Children under 3 years old – no testing is indicated because children in this age group generally do not get group A Streptococcus throat infections.
- Patients who have sore throat and other cold symptoms, like cough and congestion, because these symptoms are caused by viruses rather than bacterial infection.
Ear Infections
In children who are older than 2 years, most ear pain and ear infections will resolve on their own without antibiotics. If your child is not severely ill, waiting to start antibiotics for about 2 days after diagnosis is just as safe as starting antibiotics right away. Pain control with medications like ibuprofen or acetaminophen can help manage symptoms.
Bronchitis
Bronchitis is almost always caused by viruses and should not be treated with antibiotics.
Sinus Infections
- Sinus pressure, congestion, and green or yellow nasal drainage are very common with cold viruses and do not necessarily indicate a bacterial infection that needs antibiotics
- Antibiotics are generally not indicated unless symptoms have been persistent for at least 10 days
If my child is prescribed antibiotics, what should I expect?
It is possible that the antibiotic initially prescribed will be out of stock at the pharmacy and a new prescription may be needed. Your child may receive a different antibiotic than they have in the past for the same infection. Your child may be prescribed a tablet or capsule form that you will crush and mix with water or food. Alternative antibiotics may be more expensive or have different side effects than the antibiotics usually used for these infections. Unfortunately, in some cases, alternative antibiotic may also be less effective, which is why it is so important for clinicians and families to work together not to use antibiotics when they are not needed.
If I receive a tablet or capsule, how should I administer it to my child?
Capsules
- Oral: Open capsule and sprinkle contents into juice, apple sauce, or pudding and immediately consume.
- Feeding tube: Open capsule and disperse contents into 15-30 mL of water and immediately administer per tube. Flush with 10 mL of water.
- Should only be used for doses that can be rounded to increments of whole capsules.
Tablets
- Oral: Crush tablet to fine powder and sprinkle contents into juice, apple sauce, or pudding and immediately consume.
- Feeding tube: Crush tablet to fine powder and disperse contents into 15-30 mL of water and immediately administer per tube. Flush with 10 mL of water.
What can families do to help reduce the impact of the antibiotic shortage on all children?
The most important thing is to not take antibiotics when symptoms are likely due to viral infections. Antibiotics will not help your child if they have a virus, and will contribute to the shortage for children who do need antibiotics to treat bacterial infections. Your pediatrician will be able to explain when symptoms are likely due to a viral infection.