Shortages of antivirals and antibiotics add to the stress of a tough season for viral illnesses in children



CNN

Shortages of key drugs used to treat common childhood illnesses like the flu, ear infections and sore throats add to the misery of this year’s early and severe respiratory virus season.

“Right now we have severe drug shortages. There is no Tamiflu for children. There is practically no Tamiflu for adults. And it’s brand name and generic,” said Renae Kraft, an emergency pharmacist in Oklahoma City. Also, “when it comes to antibiotics, there aren’t that many.”

Kraft often works in rural areas of the state, floating between pharmacies when extra help is needed. On Monday, she was working in Holdenville, where there are two pharmacies: Pruett’s and Walmart. The same wholesaler stocks both stores, so if one pharmacy is sold out, the other usually is too.

Kraft estimates she had 20 people come to Pruett to fill prescriptions for Tamiflu on Monday, but she didn’t have any, so she sent them to Walmart, which still had some.

On social media, families say they searched for hours for Tamiflu and the first-line antibiotics Amoxicillin and Augmentin. Inhalers of the drug albuterol, which is used to open airways in the lungs, are also in short supply, according to the American Society of Health-System Pharmacists, which maintains a list of drug shortages.

Anyone can report a shortage for the company’s list, and University of Utah pharmacists verify information with drug manufacturers.

“In my 25 years as a pediatrician, I’ve never seen anything like it,” said Dr. Stacene Maroushek, pediatric infectious disease specialist at Hennepin Healthcare in Minnesota. “I’ve seen families who just don’t have a break. They have one viral disease after another. And now there is the side effect of ear infections and pneumonia which lead to amoxicillin shortages.

The cause of these shortages does not appear to be a manufacturing issue, says Michael Ganio, senior director of pharmacy practice and quality for the American Society of Health-System Pharmacists.

“It’s just increased demand earlier than expected and higher than usual,” he said.

According to the US Centers for Disease Control and Prevention, more than half of US states have “high” or “very high” respiratory viral activity. Most of that is due to the flu, which hit early and hard this year. Respiratory syncytial virus, or RSV, also plays a role. Nationally, about 1 in 5 tests for RSV were positive last week, a rate much higher than at any point in the past two years.

There have been about 8 flu hospitalizations per 100,000 people this season, rates typically seen in December or January. The cumulative hospitalization rate has not been this high at this point in the season for more than a decade.

The prescription is filling for the antiviral Tamiflu is at a 10-year high for this time of year, according to GoodRx.com, a company that helps people find discounts on prescription drugs.

In the United States, people are six times more likely to take Tamiflu at this point in the flu season than in winter 2019-20, which is the second highest year.

As for the antibiotics amoxicillin and Augmentin – a combination of amoxicillin and clavulanate, an agent that helps guard against antibiotic resistance – it’s unclear exactly why demand is so high.

The CDC considers them first-line therapies for many common childhood conditions, such as ear, sinus, and throat infections.

Certain viral illnesses, such as the flu, can make the body more vulnerable to secondary bacterial infections which may require treatment with antibiotics.

But these antibiotics have also been prescribed inappropriately when a child’s illness is actually caused by a virus. Antibiotics kill bacteria, but they do nothing to fight viral illnesses.

“Whenever respiratory viruses break out, people start prescribing antibiotics, even inappropriately, and that creates a lot of demand. This had not been anticipated by the manufacturers of amoxicillin, leading to shortages,” said Dr. Amesh Adalja, principal investigator at the Johns Hopkins Center for Health Security.

Pharmaceutical companies that manufacture generic drugs generally do not keep stocks of these drugs on the shelves. Instead, they manufacture drugs based on orders placed earlier in the year. Orders this year did not anticipate the peak respiratory disease season, some manufacturers said.

In response, they are increasing production, but it will take some time to get more products in stock.

Drugmaker Teva says it expects some out-of-stock strengths of amoxicillin to be back in stock from early December through late February.

Sandoz, which also makes generic amoxicillin, said the shortage had many factors. “The combination in rapid succession of the impact of the pandemic and resulting fluctuations in demand, manufacturing capacity constraints, raw material scarcity and the current energy crisis means that we are currently facing a particularly difficult situation,” the company said in a statement.

Hikma, another maker of amoxicillin, said it had sufficient supplies to fill orders and was managing its supply to ensure all orders were filled.

“We understand the importance of this drug and are looking for ways to increase production,” a spokesperson said in a statement.

The other companies that make amoxicillin and those that make Tamiflu and its generics did not respond to CNN’s request for comment.

The US Food and Drug Administration has taken steps to help amid the shortage, giving advice to pharmacists on how to make liquid amoxicillin for children. pill versions. There’s no shortage of amoxicillin pills for adults, Ganio said.

While news of these shortages may generate some anxiety, parents should be aware but not alarmed, said Brigid Groves, pharmacist and senior director of practice and professional affairs at the American Pharmacists Association.

The most important thing families can do for a sick loved one is get them tested, she said. Most doctor’s offices and some pharmacies can perform rapid tests to help determine if your symptoms are from a viral or bacterial illness.

“We don’t want to treat someone who has Covid with an antibiotic because that’s not going to be effective,” Groves said. “And then we also run the risk of creating more resistance in our current bacterial antimicrobial agents.”

A recent study by the Pew Charitable Trusts concluded that approximately 30% of outpatient antibiotic prescriptions for children were inappropriate, either because the drugs were given to treat viral illnesses or because the recommended agent was not used. Additionally, the study found that antibiotics increase the risk of C. diff, a bacterial infection that can be life-threatening; allergic reactions; and skin rashes.

“It is important for a family or caregiver to have their loved one assessed appropriately to ensure that whatever treatment they are being treated for, they will receive the appropriate treatment,” Groves said. This can be a viral illness or bacterial infection, or a condition that requires medications like albuterol for supportive care, making sure the medication is used appropriately for children who are wheezing or have trouble breathing.

Groves also said parents should be aware that it can take a bit of hunting to fill a child’s prescription for Tamiflu or amoxicillin. They may have to drive further or go to a store they don’t know.

If all the stores in the area are closed, she says, it may be possible to get a prescription for a different antibiotic or antiviral.

“There are options for treating the same infection with a different agent,” she said.

A compounding pharmacy may also be able to mix the medications you need.

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