Of all of the medicines we associate with care of children Amoxicillin has to be at the top of the list. In early November 2023 we are experiencing a national shortage of ALL amoxicillin oral liquid preparations. Amoxicillin/clavulanate (Augmentin) is okay for now but there will likely be a trickle down effect curtailing its availability in the near future.. The reason is ongoing supply chain issues. Here are some recommendations on how to deal with this shortage

First and foremost – don’t treat viral illnesses with antibiotics! I know, I know, I’m preaching to the choir here, but really make sure that you diagnosis of illnesses such as acute otitis media and community acquired pneumonia are precise. Here’re links to the current guidelines for some common sinopulmonary diagnoses that could have amoxicillin or amoxicillin/clavulanate as treatment options.

If you do need to treat with amoxicillin there are solid products that can be crushed, and capsules that can be opened. Here are some alternative options:

amoxicillin 250mg chewable tablets
amoxicillin 250mg capsules
amoxicillin 500mg capsules
amoxicillin 875mg tablets

You can still order the amoxicillin suspension – but you never know when we will run out. Penicillin is still widely available and though less palatable it’ll get the job done. Hospitals are looking into compounding their own suspension in house. You should also advocate for pharmacy involvement on the EMR end to automatically suggest alternatives in realtime.

References

Allan S. Lieberthal, Aaron E. Carroll, Tasnee Chonmaitree, Theodore G. Ganiats, Alejandro Hoberman, Mary Anne Jackson, Mark D. Joffe, Donald T. Miller, Richard M. Rosenfeld, Xavier D. Sevilla, Richard H. Schwartz, Pauline A. Thomas, David E. Tunkel; The Diagnosis and Management of Acute Otitis Media. Pediatrics March 2013; 131 (3): e964–e999. 10.1542/peds.2012-3488

John S. Bradley, Carrie L. Byington, Samir S. Shah, Brian Alverson, Edward R. Carter, Christopher Harrison, Sheldon L. Kaplan, Sharon E. Mace, George H. McCracken, Jr, Matthew R. Moore, Shawn D. St Peter, Jana A. Stockwell, Jack T. Swanson, The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 53, Issue 7, 1 October 2011, Pages e25–e76, https://doi.org/10.1093/cid/cir531

Ellen R. Wald, Kimberly E. Applegate, Clay Bordley, David H. Darrow, Mary P. Glode, S. Michael Marcy, Carrie E. Nelson, Richard M. Rosenfeld, Nader Shaikh, Michael J. Smith, Paul V. Williams, Stuart T. Weinberg; Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years. Pediatrics July 2013; 132 (1): e262–e280. 10.1542/peds.2013-1071

2021. “Group A Streptococcal Infections”, Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics, David W. Kimberlin, MD, FAAP, Elizabeth D. Barnett, MD, FAAP, Ruth Lynfield, MD, FAAP, Mark H. Sawyer, MD, FAAP