Tips about baby sitters and potty training have taken a back seat on parenting websites. They’ve been pushed aside by growing anxieties over a nationwide shortage of a common antibiotic suddenly in high demand to treat complications from a flood of childhood respiratory infections.
Amoxicillin, a decades old medication, has been hard to find lately in its liquid formulation, which is typically prescribed for young children. Late last month, the Food and Drug Administration announced the powder used to prepare the solution was in short supply.
The convergence this fall of an early, aggressive flu season, combined with a surge in RSV, or respiratory syncytial virus, which is most threatening to young children, has spawned secondary infections in many youngsters.
“I got an automated call from CVS saying we don’t have your medication, and I was on hold forever. The next three hours were beyond hellacious,” said Jennifer Cronin, an Ashland mother who frantically tried to fill an amoxicillin prescription Thursday for her 4-year old son’s ear infection.
Cronin called her pediatrician, who sent the pharmacy a prescription for an alternate antibiotic.
“We drove all the way to the CVS, waited in line, got up to the counter, and they said,’ We don’t have that medication either,’” she said.
For the next several hours, Cronin and her husband worked the phones, calling pharmacies and their pediatrician. Finally they were able to fill the prescription for amoxicillin at another store.
Antibiotics do not work for viral infections, but RSV, influenza, and the common cold can trigger secondary bacterial infections, such as pneumonia and ear infections, for which antibiotics are effective.
These viruses often lead to excess mucus that can harbor bacteria, said Dr. Mary Beth Miotto president of the Massachusetts chapter of the American Academy of Pediatrics and staff pediatrician at the Mattapan Community Health Center.
“As most parents know, what starts out as a cold or upper respiratory infection sometimes causes ear infections and pneumonia in children, especially young children,” Miotto said. “In speaking to my colleagues, we all have seen a lot more ear infections than we have seen in a long time.”
No child is being denied a needed antibiotic, Miotto said. When amoxicillin isn’t available, doctors can prescribe an alternative.
“I don’t think any of us consider it a crisis,” she said. “It just needs some flexibility and collaboration.”
Dr. Paul Biddinger, chief preparedness and continuity officer for Mass General Brigham, the state’s largest health system, said he is hearing from a lot of pediatric practices that are asking their staff to help anxious parents find pharmacies that still have the pediatric formulations of amoxicillin.
“That is taking a lot of time in pediatric practices that are already under enormous strain,” Biddinger said.
“The increasing frequency with which we are seeing shortages of standard common-use medicines, like amoxicillin and others, is very concerning,” he said. “It speaks to the fragility of the medical supply chain, and the next shortage that we don’t know about could seriously affect patient care for a lot of people.”
Another shortage of concern is a solution used in hospitals, called albuterol sulfate, that children breathe in through a nebulizer to ease severe asthma symptoms.
“So far, we have been able to manage with workarounds and other formulations,” Biddinger said.
Shannon Manzi, director of safety and quality in the pharmacy department at Boston Children’s Hospital, said they are vigilant when administering nebulizers to not waste a drop of the medication. Albuterol packaged in larger amounts, typically used by hospitals, is what’s in short supply. So, Manzi said, their pharmacy technicians spend time loading dozens of smaller packets of the solution into each four-hour nebulizer.
“You have to open over 100 of the packets for one, continuous nebulizer, for one four-hour [dose],” Manzi said. “You multiply that by more than one patient, and more than one four-hour block, that is a workforce problem.”
Several pharmaceutical experts who track medications said the amoxicillin and albuterol shortages are not nearly as acute as previous shortages of other drugs.
“Over the last 10 years, we have often had significant drug shortages,” said Jeffrey Pilz, assistant director of pharmacy, medication safety, and drug policy at the Ohio State University Wexner Medical Center.
When Hurricane Maria ravaged Puerto Rico in 2017, it took out many of the manufacturers that produce vital pharmaceuticals widely used in the United States, such as sodium chloride, known as saline, used to rehydrate patients. That resulted in shortages as manufacturers scrambled to come back online.
Pilz and other pharmaceutical experts said it’s hard to know the exact reasons for many drug shortages, or more importantly, how long they may last, because manufacturers aren’t required to provide much information to the FDA. But Pilz said the current shortage of amoxicillin and albuterol do not appear to be related to supply-chain or production issues, rather more related to supply and demand.
Manzi, of Boston Children’s Hospital, said it’s more important than ever to ensure that health care providers are not prescribing antibiotics to children and other patients for infections caused by viruses.
Overuse and inappropriate prescribing of antibiotics and other medications designed to kill germs is fueling a rising problem known as antimicrobial resistance. That happens when germs such as bacteria or fungi no longer respond to the drugs designed to kill them. And that means these germs continue to grow.
“We need to make sure that people understand [inappropriate use] will not help,” Manzi said, “and it may make things worse.”
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