Pharmacies are running low on the pediatric form of the antibiotic amoxicillin for the second year in a row.
While pharmacies say they can still fill most prescriptions for amoxicillin, the most-prescribed drug in the country, the shortage could worsen when viral season hits this winter, experts say.
“This amoxicillin shortage is particularly concerning because it’s a first line for many pediatric conditions,” said Sameer Patel, an infectious diseases physician at Lurie Children’s Hospital.
The Food and Drug Administration has listed the powdered version of the drug in short supply since October 2022. That version is prescribed for children because it can be taken in liquid form.
Drugstore chains Walgreens and CVS say they have taken steps to meet demand in the face of the industrywide shortage. A Walgreens spokesperson said Wednesday, “We can fill the majority of prescriptions at this time.”
Walgreens and CVS said they direct patients to nearby locations or alternate medication when a pharmacy runs out of the drug.
Doctors from Lurie Children’s and Northwestern Memorial hospitals say they haven’t run into supply issues yet, but they expect to do so when the viral season ramps up. Both hospitals have plans for dealing with the shortage that include which alternate medications to prescribe.
Patel expects scarcity to be an issue this year, since the FDA is still reporting a dearth of the drug, but it’s hard to predict how bad it will be.
Pharmaceutical manufacturers have blamed the shortage on high demand. But experts say some companies don’t prioritize making less profitable generic drugs like amoxicillin, which isn’t patented. Prescriptions for amoxicillin run about $10.
“There’s not as much of a financial incentive to respond because the reimbursement to companies is low for amoxicillin,” said Timothy Classen, associate professor at Loyola University’s Quinlan School of Business.
He experienced the amoxicillin shortage firsthand last year when he had to travel to three different pharmacies in the Chicago area to find the drug for his young child.
Amoxicillin is facing a shortage for other reasons, too. The drug was widely prescribed last year during a severe viral season, Patel said. And global supply chain issues have affected drug stocks in the United States, Patel said.
Many forms of amoxicillin have been placed on “allocation,” meaning manufacturers limit the amount of the drug they sell to any particular wholesaler so that it is stocked in as many pharmacies as possible.
Companies are required to report drug shortages to the Food and Drug Administration. But the FDA doesn’t share all of the reasons for the shortage or when the shortage is expected to end, Patel said.
“That creates a lot of uncertainty for doctors,” Patel said.
What’s encouraging is that many drugs can be prescribed as an alternative to amoxicillin. These medications include cefuroxime, cephalexin and clindamycin, said Sterling Elliott, a clinical pharmacist at Northwestern University Feinberg School of Medicine.
But those drugs are considered stronger, and target a wider range of bacteria, which could contribute to antibacterial resistance later.
“That’s always a concern for doctors. If we use something else, do we open ourselves up to a resistance problem down the road?” Elliott said.