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Just as winter looms and everyone heads inside to cough, sneeze, and spread germs, a shortage of a popular antibiotic has developed. The U.S. Food and Drug Administration (FDA) has assigned “currently in shortage” status to oral powder for suspension amoxicillin. In fact, as of Oct. 28, the FDA listed 23 amoxicillin products on its current drug shortages page due to increased demand for the drug.
The American Society of Health-Systems Pharmacists (ASHP) has also posted on its website a list of the various oral amoxicillin products that are currently in short supply. The list includes oral powder for suspension, tablets, chewable tablets, and capsules.
What is amoxicillin?
Amoxicillin is a penicillin antibiotic. If you’ve ever received a prescription for a drug named Amoxil or Trimox, then you’ve taken amoxicillin. Augmentin also contains this drug (along with clavulanic acid, which helps prevent bacterial resistance).
Amoxicillin is very commonly used to treat bacterial ear infections, respiratory infections, and other common bacterial illnesses like strep throat. As with other antibiotics, amoxicillin is not an appropriate treatment for viral infections such as the common cold, influenza, respiratory syncytial virus infection (RSV), or COVID-19. But, it can treat certain secondary, bacterial infections sometimes caused by these illnesses.
Why is there an amoxicillin shortage?
Amoxicillin is one of the most commonly prescribed antibiotics in the U.S. On top of that, there has been a surge of respiratory infections this fall—as kids go back to school and daycare, germs are passed around.
Most of the products in short supply are the powder for oral suspension that is mixed with water at the pharmacy to become a liquid formulation of the drug, which is often used to treat young children. This could cause headaches for pediatricians and other providers who usually prescribe this medication to their young patients—and could send healthcare providers scrambling to choose an alternative to prescribe to their patients.
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Which formulations are affected?
Currently, the shortage affects oral amoxicillin products from several pharmaceutical manufacturers.
Some of the oral amoxicillin products from pharmaceutical manufacturer Sandoz are listed on the FDA’s webpage as having limited availability, while others are deemed unavailable.
Meanwhile, four products made by Hikma Pharmaceuticals are listed as available for current customers, and four oral amoxicillin products from Aurobindo and four from Teva Pharmaceuticals are listed as “on allocation.” ASHP defines a product on allocation as “one that is distributed in a manner that limits distribution of scarce supplies until a shortage is resolved,” which can include placing limits on the amount sold or limiting the available supplies to the most needy individuals with life-threatening conditions.
Should parents be worried?
“No, not necessarily,” says Laura K. Grubb, MD, MPH, board-certified pediatrician and member of the SingleCare medical review board. “Most common infections in young children are viral and do not require antibiotics. The most uses for amoxicillin in young children are ear infections and urinary tract infections and there are sufficient other suitable, effective antibiotics.”
The amoxicillin shortage may feel worrisome for parents, as it hits just at the start of cold and flu season—which can easily progress to an ear infection or sinus infection. It may feel especially alarming, as it comes on the heels of the recent Adderall shortage, and the formula shortage earlier this year.
However, for most ailments that amoxicillin treats, there is another option. If your child can swallow pills, that form of amoxicillin may be available. Or, if you get to the pharmacy and find that the medication is out of stock, your pharmacist can contact your provider for an alternative treatment.
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What are the alternatives to amoxicillin?
“Alternative antibiotic choices depend on the infection. For ear infections, health care providers can consider common cephalosporins such as cephalexin, cefuroxime, cefixime, and cefdinir,” explains Dr. Grubb. “For urinary tract infections, health care providers can prescribe a cephalosporin, sulfamethoxazole and trimethoprim (Bactrim), or nitrofurantoin. For pneumonia, a cephalosporin is a good choice. For upper respiratory infections, the culprit is viral, so antibiotics are not indicated.”
Some options your provider might prescribe include:
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When will the shortage end?
No one can say definitively when the amoxicillin shortage will end. The FDA has not stated when they expect the shortage to conclude.
However, some products that are listed as currently unavailable on the FDA’s drug shortages webpage include a mention of when a limited supply is expected to be available. For example, some products from the pharmaceutical company Sandoz are expected to be available in limited supply before the end of 2022. However, others are not projected to become available in limited supply until the first quarter of 2023. The ASHP also reports on its webpage that Rising Pharmaceuticals has several types of amoxicillin capsules and tablets available. This is a situation that can change daily, so be sure to check with your provider or pharmacy before worrying.